Provider Demographics
NPI:1265550743
Name:IEZZA, ALEXANDER PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:PAUL
Last Name:IEZZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:950 ALICE LN APT #3
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-248-5443
Mailing Address - Fax:
Practice Address - Street 1:208 CONCOURSE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8210
Practice Address - Country:US
Practice Address - Phone:707-544-3400
Practice Address - Fax:707-544-0137
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92670207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A92670Medicaid