Provider Demographics
NPI:1073508917
Name:ALFONSO, DON JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:JOSEPH
Last Name:ALFONSO
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 1:84 PINNACLES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2324
Mailing Address - Country:US
Mailing Address - Phone:386-439-9777
Mailing Address - Fax:386-439-0800
Practice Address - Street 1:84 PINNACLES DR STE 200
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2324
Practice Address - Country:US
Practice Address - Phone:386-439-9777
Practice Address - Fax:386-439-0800
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253950100Medicaid
FLG16732Medicare UPIN
FL27571YMedicare ID - Type Unspecified21763 GROUP NUMBER