Provider Demographics
NPI:1497837405
Name:ALEGRIA, FERNANDO J (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:J
Last Name:ALEGRIA
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:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-0500
Mailing Address - Country:US
Mailing Address - Phone:334-289-3755
Mailing Address - Fax:334-289-3766
Practice Address - Street 1:105 HWY 80 EAST
Practice Address - Street 2:SUIT 225
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732
Practice Address - Country:US
Practice Address - Phone:334-289-3755
Practice Address - Fax:334-289-3766
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025440208600000X
OH35042412A208600000X
MN34132208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51518299OtherBCBS
AL51518299OtherBCBS