Provider Demographics
NPI:1679552848
Name:ALFONSO, GILBERTO JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:JORGE
Last Name:ALFONSO
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 1:2719 NEUSE BLVD
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2852
Mailing Address - Country:US
Mailing Address - Phone:252-633-6117
Mailing Address - Fax:252-633-2644
Practice Address - Street 1:2719 NEUSE BLVD
Practice Address - Street 2:SUITE B & C
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2852
Practice Address - Country:US
Practice Address - Phone:252-633-6117
Practice Address - Fax:252-633-2644
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400008207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2195913AMedicare PIN
C82274Medicare UPIN