Provider Demographics
NPI:1467497271
Name:ALSTOTT, JERRY MARTIN (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:MARTIN
Last Name:ALSTOTT
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 1:8030 SAINT JAMES WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-9134
Mailing Address - Country:US
Mailing Address - Phone:407-908-0064
Mailing Address - Fax:352-383-9319
Practice Address - Street 1:8030 SAINT JAMES WAY
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-9134
Practice Address - Country:US
Practice Address - Phone:407-908-0064
Practice Address - Fax:352-383-9319
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037307207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046349300Medicaid
FL046349300Medicaid
FL14023Medicare ID - Type Unspecified