Provider Demographics
NPI:1588634182
Name:JOHN, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:JOHN
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 1:875 ROOSEVELT HWY
Mailing Address - Street 2:SUITE 132
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4460
Mailing Address - Country:US
Mailing Address - Phone:802-864-7483
Mailing Address - Fax:802-660-4337
Practice Address - Street 1:875 ROOSEVELT HWY
Practice Address - Street 2:SUITE 132
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4460
Practice Address - Country:US
Practice Address - Phone:802-864-7483
Practice Address - Fax:802-660-4337
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008088207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009787Medicaid
VT00008385OtherBLUE CROSS/BLUE SHIELD
VT9787Medicare ID - Type Unspecified
VT00008385OtherBLUE CROSS/BLUE SHIELD