Provider Demographics
NPI:1386176824
Name:STRAUSS, ALEX THOMAS
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:THOMAS
Last Name:STRAUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W TAYLOR AVE
Mailing Address - Street 2:#5
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2542
Mailing Address - Country:US
Mailing Address - Phone:518-871-3200
Mailing Address - Fax:
Practice Address - Street 1:528 W TAYLOR AVE
Practice Address - Street 2:#5
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2542
Practice Address - Country:US
Practice Address - Phone:518-871-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other