Provider Demographics
NPI:1619962495
Name:ALFANO, PETER F (PA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:F
Last Name:ALFANO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 NALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2504
Mailing Address - Country:US
Mailing Address - Phone:816-943-0706
Mailing Address - Fax:913-451-1754
Practice Address - Street 1:12140 NALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2504
Practice Address - Country:US
Practice Address - Phone:816-943-0706
Practice Address - Fax:913-451-1754
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501902363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506330Medicaid
TN1506330Medicaid
TN3666963Medicare PIN