Provider Demographics
NPI:1649222514
Name:CHEN, ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:CHEN
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 1:14505 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2789
Mailing Address - Country:US
Mailing Address - Phone:813-971-5533
Mailing Address - Fax:813-910-7828
Practice Address - Street 1:14505 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2789
Practice Address - Country:US
Practice Address - Phone:813-971-5533
Practice Address - Fax:813-910-7828
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00575742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry