Provider Demographics
NPI:1245429703
Name:DR ALPHONSE R TRIBUIANI PA
Entity type:Organization
Organization Name:DR ALPHONSE R TRIBUIANI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRIBUIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-949-2121
Mailing Address - Street 1:9250 CORKSCREW RD STE 7
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3216
Mailing Address - Country:US
Mailing Address - Phone:239-949-2121
Mailing Address - Fax:239-597-5388
Practice Address - Street 1:9250 CORKSCREW RD STE 7
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3216
Practice Address - Country:US
Practice Address - Phone:239-959-2121
Practice Address - Fax:239-597-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2858213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480030357OtherRAILROAD MEDICARE
FLK1920Medicare PIN
FL3895530001Medicare NSC
FLU080991Medicare UPIN