Provider Demographics
NPI:1558368787
Name:LLANO, ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:LLANO
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 43130
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3130
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:7383 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3475
Practice Address - Country:US
Practice Address - Phone:520-318-3434
Practice Address - Fax:520-296-6224
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223311174400000X
AZ41384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA219970OtherANTHEM BC/BS
541910047OtherCIGNA
298373OtherMDIPA/MAMSI/OPTIMUM
541910047OtherAETNA
PA603296OtherBC/BS PENNSYLVANIA
110231194OtherRAILROAD MEDICARE
NC8906415Medicaid
FL911940000Medicaid
VA005863571Medicaid
VA51574OtherSENTARA OPTIMA
298373OtherMDIPA/MAMSI/OPTIMUM
NC8906415Medicaid