Provider Demographics
NPI:1982144721
Name:ALONSO, EDSON PEREIRA JR
Entity Type:Individual
Prefix:MR
First Name:EDSON
Middle Name:PEREIRA
Last Name:ALONSO
Suffix:JR
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 1:7009 ROMANA WAY APT 1603
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9637
Mailing Address - Country:US
Mailing Address - Phone:801-762-7291
Mailing Address - Fax:
Practice Address - Street 1:7009 ROMANA WAY APT 1603
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9637
Practice Address - Country:US
Practice Address - Phone:801-762-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9388679367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered