Provider Demographics
NPI:1205849460
Name:ALEJANDRO, LUIS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ALEJANDRO
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 1:5817 HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7053
Mailing Address - Country:US
Mailing Address - Phone:336-218-0066
Mailing Address - Fax:336-218-7053
Practice Address - Street 1:5817 HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7053
Practice Address - Country:US
Practice Address - Phone:336-218-0066
Practice Address - Fax:336-218-7053
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131K9Medicaid
NC131K9OtherBCBS OF NC
NC131K9OtherBCBS OF NC
H68375Medicare UPIN