Provider Demographics
NPI:1639180011
Name:ALONSO, JASON ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALEXANDER
Last Name:ALONSO
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 1:202 S. PARKER STREET
Mailing Address - Street 2:UNIT 776
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606
Mailing Address - Country:US
Mailing Address - Phone:305-298-6275
Mailing Address - Fax:
Practice Address - Street 1:202 S. PARKER STREET
Practice Address - Street 2:UNIT 776
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:305-298-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 64889207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250777300Medicaid
FLG31942Medicare UPIN