Provider Demographics
NPI:1689068215
Name:ALEX STUDEMEISTER MD INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALEX STUDEMEISTER MD INC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-323-2312
Mailing Address - Street 1:105 N BASCOM AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1811
Mailing Address - Country:US
Mailing Address - Phone:408-993-1500
Mailing Address - Fax:
Practice Address - Street 1:105 N BASCOM AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1811
Practice Address - Country:US
Practice Address - Phone:408-993-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57832207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty