Provider Demographics
NPI:1184741266
Name:ALANIS, FIDENCIO T (MD)
Entity type:Individual
Prefix:DR
First Name:FIDENCIO
Middle Name:T
Last Name:ALANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3156 DUSTIN RD STE 401
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4358
Mailing Address - Country:US
Mailing Address - Phone:419-698-8660
Mailing Address - Fax:419-698-8679
Practice Address - Street 1:3156 DUSTIN RD
Practice Address - Street 2:SUITE 401
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4353
Practice Address - Country:US
Practice Address - Phone:419-729-5427
Practice Address - Fax:419-729-5428
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35034517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199057Medicaid