Provider Demographics
NPI:1578676953
Name:USON, ALEX MARIN (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:MARIN
Last Name:USON
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 1:1039 W DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6349
Mailing Address - Country:US
Mailing Address - Phone:352-323-0094
Mailing Address - Fax:
Practice Address - Street 1:1039 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6349
Practice Address - Country:US
Practice Address - Phone:352-323-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25804OtherBCBS PROVIDER NUMBER
FLF89930Medicare UPIN