Provider Demographics
NPI:1487824041
Name:ALFREDA, THOMAS A JR (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:ALFREDA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2779 W HORIZON RIDGE PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4186
Mailing Address - Country:US
Mailing Address - Phone:702-666-8645
Mailing Address - Fax:702-666-0401
Practice Address - Street 1:2779 W HORIZON RIDGE PKWY STE 207
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-666-8645
Practice Address - Fax:702-666-0401
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20080207R00000X
FL17601207R00000X
NVDO1536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDQ114ZMedicare PIN