Provider Demographics
NPI:1578635645
Name:KLISTOFF, ALEXANDER JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOHN
Last Name:KLISTOFF
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:11583 C AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2703
Mailing Address - Country:US
Mailing Address - Phone:530-886-3454
Mailing Address - Fax:530-889-7276
Practice Address - Street 1:11583 C AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2703
Practice Address - Country:US
Practice Address - Phone:530-886-3454
Practice Address - Fax:530-889-7276
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG37960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37960OtherLICENSE NUMBER
CA00G379600OtherPIN # MEDICARE
CAAK9397060OtherDEA #
CAA47305Medicare UPIN