Provider Demographics
NPI:1922088541
Name:ALSON, ALFRED LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:LEWIS
Last Name:ALSON
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 1:28 OLD KINGS RD N
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8226
Mailing Address - Country:US
Mailing Address - Phone:386-445-0554
Mailing Address - Fax:386-445-5242
Practice Address - Street 1:28 OLD KINGS RD N
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8226
Practice Address - Country:US
Practice Address - Phone:386-445-0554
Practice Address - Fax:386-445-5242
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49944208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046653100Medicaid
FLD51023Medicare UPIN
FL04464Medicare ID - Type Unspecified