Provider Demographics
NPI:1932723913
Name:ALONSO, KENNETH (MD)
Entity type:Individual
Prefix:PROF
First Name:KENNETH
Middle Name:
Last Name:ALONSO
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 1:419 S PALOMA PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3711
Mailing Address - Country:US
Mailing Address - Phone:941-725-5651
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MEDICINE AND HEALTH SCIENCES
Practice Address - Street 2:
Practice Address - City:BASSETERRE
Practice Address - State:CAMPS
Practice Address - Zip Code:00000
Practice Address - Country:KN
Practice Address - Phone:869-767-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16011207RX0202X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology