Provider Demographics
NPI:1316196512
Name:COLFRY, ALFRED JOHN III (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JOHN
Last Name:COLFRY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 PRYTANIA ST
Mailing Address - Street 2:STE. 35, CRESCENT CITY PHYSICIANS, INC.
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3628
Mailing Address - Country:US
Mailing Address - Phone:504-897-7197
Mailing Address - Fax:
Practice Address - Street 1:3434 PRYTANIA ST
Practice Address - Street 2:STE. 320, CRESCENT CITY PHYSICIANS, INC.
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3572
Practice Address - Country:US
Practice Address - Phone:504-897-7142
Practice Address - Fax:504-210-4286
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003300282N00000X
TXQ0027208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338942101 (MDACC)Medicaid
TX351889YKQH (MDACC)Medicare PIN