Provider Demographics
NPI:1336728930
Name:DE JONG, ALEXANDER LUKE
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LUKE
Last Name:DE JONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 CHATEAU AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2639
Mailing Address - Country:US
Mailing Address - Phone:512-573-2055
Mailing Address - Fax:
Practice Address - Street 1:15905 CHATEAU AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-2639
Practice Address - Country:US
Practice Address - Phone:512-573-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program