Provider Demographics
NPI:1275651507
Name:ALEX J ONOFREI MD PC
Entity Type:Organization
Organization Name:ALEX J ONOFREI MD PC
Other - Org Name:AZ FAMILY MEDICINE & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIJA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-807-3554
Mailing Address - Street 1:6130 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4960
Mailing Address - Country:US
Mailing Address - Phone:480-807-3554
Mailing Address - Fax:480-807-8330
Practice Address - Street 1:6130 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4960
Practice Address - Country:US
Practice Address - Phone:480-807-3554
Practice Address - Fax:480-807-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24575207Q00000X, 207QS0010X
AZ26832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106145OtherMEDICARE ID-PIN
AZZ106145OtherMEDICARE ID-PIN