Provider Demographics
NPI:1710931688
Name:ALONSO, JORGE E (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:E
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:3421 MEDICAL PARK DR
Practice Address - Street 2:MED PARK II
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3330
Practice Address - Country:US
Practice Address - Phone:251-665-8200
Practice Address - Fax:251-665-8210
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL1748207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010033CD32883OtherSECTION 1011
AL051529634OtherBLUE CROSS
ALD32883OtherVIVA
AL000080124OtherBLUE CROSS
AL009932414Medicaid
AL51592978OtherBCBS - 3421 MED PK DR
AL000080124Medicaid
ALD32883OtherVIVA
AL000080124OtherBLUE CROSS
AL051529634OtherBLUE CROSS