Provider Demographics
NPI:1720105547
Name:ALFREDSON, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ALFREDSON
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:PO BOX 2361
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-1361
Mailing Address - Country:US
Mailing Address - Phone:931-276-2234
Mailing Address - Fax:931-276-2233
Practice Address - Street 1:529 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-3219
Practice Address - Country:US
Practice Address - Phone:931-276-2234
Practice Address - Fax:931-276-2233
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 132802085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN149997OtherBLUE CROSS BLUE SHIELD TN
TN3185437Medicaid
3185437Medicare PIN
B04189Medicare UPIN