Provider Demographics
NPI:1710926605
Name:SANTOS, ALFONSO HERNANDEZ JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:HERNANDEZ
Last Name:SANTOS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-9180
Mailing Address - Fax:352-265-8244
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-9180
Practice Address - Fax:352-265-8244
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17497207R00000X
FLME104708207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125256Medicaid
FLCI287ZMedicare PIN
MS110001523Medicare ID - Type UnspecifiedMEDICARE
MS00125256Medicaid