Provider Demographics
NPI:1851361299
Name:DESIMONE, ALFRED ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:ALEXANDER
Last Name:DESIMONE
Suffix:
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 1:220 SW 84TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2729
Mailing Address - Country:US
Mailing Address - Phone:954-349-2345
Mailing Address - Fax:954-641-1080
Practice Address - Street 1:1600 TOWN CENTER BLVD STE C
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3641
Practice Address - Country:US
Practice Address - Phone:954-389-5900
Practice Address - Fax:954-389-5751
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68002207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002615000Medicaid
FLK0493OtherMEDICARE GROUP
FLP00429747OtherRR MEDICARE
FL002876700OtherGROUP MEDICAID
27195ZMedicare PIN
3983290001Medicare NSC
FL002615000Medicaid