Provider Demographics
NPI:1942289517
Name:ALFARO, ANGELA D (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:D
Last Name:ALFARO
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2507
Mailing Address - Street 2:
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686-2507
Mailing Address - Country:US
Mailing Address - Phone:907-835-2532
Mailing Address - Fax:907-835-2362
Practice Address - Street 1:154 FAIRBANKS DRIVE
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686-2507
Practice Address - Country:US
Practice Address - Phone:907-835-2532
Practice Address - Fax:907-835-2362
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84803207Q00000X
AKMEDS6502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267045300Medicaid
FLP00402876OtherRAILROAD MEDICARE NUMBER
FL267045300Medicaid
FL62197XMedicare ID - Type Unspecified