Provider Demographics
NPI:1740264761
Name:TRIBUIANI, ALPHONSE R (DPM)
Entity type:Individual
Prefix:
First Name:ALPHONSE
Middle Name:R
Last Name:TRIBUIANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:239-949-2121
Practice Address - Fax:239-597-5388
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02858213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4800030357OtherRAILROAD MEDICARE
FL3895530001Medicare NSC
FL480030357Medicare PIN
U80991Medicare UPIN
FL65671YMedicare PIN
FL4800030357OtherRAILROAD MEDICARE