Provider Demographics
NPI:1144200106
Name:ALICEA, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:ALICEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2559 MEDICAL DR STE 3100
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:575-446-5700
Mailing Address - Fax:888-987-7176
Practice Address - Street 1:2559 MEDICAL DR STE 3100
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:575-446-5700
Practice Address - Fax:888-987-7176
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM97-2207X00000X
TXJ6846207X00000X
AZ46783207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ779513Medicaid
NM96026359Medicaid
TX124214102Medicaid