Provider Demographics
NPI:1134236128
Name:FIGUEROA, ALFREDO HERNAN (MD)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:HERNAN
Last Name:FIGUEROA
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 1:501 MARSHALL ST
Mailing Address - Street 2:STE 104
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1651
Mailing Address - Country:US
Mailing Address - Phone:601-969-6404
Mailing Address - Fax:601-973-4541
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:STE 104
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-969-6404
Practice Address - Fax:601-973-4541
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11545207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
753068151Other1ST CHOICE
753068151OtherMHP
753068151016OtherTRICARE
753068151OtherUHC
753068151OtherMPCN
MS00117797Medicaid
MS00117797Medicaid
MS00117797Medicaid
060000203Medicare ID - Type Unspecified
F14141Medicare UPIN