Provider Demographics
NPI:1386604346
Name:ALTER, ALBERT JERVISS JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JERVISS
Last Name:ALTER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:W9107 STATE ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:BLANCHARDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53516-9671
Mailing Address - Country:US
Mailing Address - Phone:608-523-4506
Mailing Address - Fax:608-271-7015
Practice Address - Street 1:6701 SEYBOLD RD
Practice Address - Street 2:STE 204
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1362
Practice Address - Country:US
Practice Address - Phone:608-271-7015
Practice Address - Fax:608-271-7015
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2019-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI19772-0202085B0100X, 2085N0904X, 2085U0001X, 2085R0202X
WI197722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31053200Medicaid
WI31053200Medicaid