Provider Demographics
NPI:1225364755
Name:ALONSO, ALFREDO N (IDC)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:N
Last Name:ALONSO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS DOYLE
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:34090-1494
Mailing Address - Country:US
Mailing Address - Phone:904-270-5480
Mailing Address - Fax:903-270-5973
Practice Address - Street 1:USS DOYLE FFG 39
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34090-1494
Practice Address - Country:US
Practice Address - Phone:904-270-5480
Practice Address - Fax:903-270-5973
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman