Provider Demographics
NPI:1316996168
Name:JACOME, ALFREDO (MD, PA)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:
Last Name:JACOME
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 SW 22ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7066
Mailing Address - Country:US
Mailing Address - Phone:352-861-5333
Mailing Address - Fax:
Practice Address - Street 1:2121 SW 22ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7766
Practice Address - Country:US
Practice Address - Phone:352-861-5333
Practice Address - Fax:352-861-5334
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250011600Medicaid
28907Medicare ID - Type Unspecified
FL250011600Medicaid