Provider Demographics
NPI:1760977425
Name:ALONZO, RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:ALONZO
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 1:2014 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5235
Mailing Address - Country:US
Mailing Address - Phone:574-533-8639
Mailing Address - Fax:574-534-9542
Practice Address - Street 1:2014 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5235
Practice Address - Country:US
Practice Address - Phone:574-533-8639
Practice Address - Fax:574-534-9542
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01084341A207QA0401X, 208D00000X, 207Q00000X, 207Q00000X
IN11020188A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice