Provider Demographics
NPI:1427138510
Name:AFLATOONI, ALFRED (M D)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:AFLATOONI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4230
Mailing Address - Country:US
Mailing Address - Phone:360-373-6656
Mailing Address - Fax:360-373-6646
Practice Address - Street 1:2641 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4230
Practice Address - Country:US
Practice Address - Phone:360-373-6656
Practice Address - Fax:360-373-6646
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAF7008OtherREGENCE
VA1197102Medicaid
VA1197102Medicaid
WAAF7008OtherREGENCE