Provider Demographics
NPI:1750440319
Name:DE MOURA, ALEXANDRE B (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRE
Middle Name:B
Last Name:DE MOURA
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 1:761 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6608
Mailing Address - Country:US
Mailing Address - Phone:516-357-8777
Mailing Address - Fax:516-357-7251
Practice Address - Street 1:761 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6608
Practice Address - Country:US
Practice Address - Phone:516-357-8777
Practice Address - Fax:516-357-7251
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1194051207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine