Provider Demographics
NPI:1285731489
Name:ANTHONY ALATRISTE MD PA FAMILY MEDICINE
Entity type:Organization
Organization Name:ANTHONY ALATRISTE MD PA FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALATRISTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-299-6160
Mailing Address - Street 1:1768 PARK CENTER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6200
Mailing Address - Country:US
Mailing Address - Phone:407-299-6160
Mailing Address - Fax:407-299-9141
Practice Address - Street 1:1768 PARK CENTER DR
Practice Address - Street 2:STE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6200
Practice Address - Country:US
Practice Address - Phone:407-299-6160
Practice Address - Fax:407-299-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0070004208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28461FMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLG24424Medicare UPIN