1184798027 NPI number — DR. CONNIE ELIZABETH ALFORD M.D.

Table of content: DR. CONNIE ELIZABETH ALFORD M.D. (NPI 1184798027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184798027 NPI number — DR. CONNIE ELIZABETH ALFORD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALFORD
Provider First Name:
CONNIE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARTRUFF
Provider Other First Name:
CONNIE
Provider Other Middle Name:
ALFORD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184798027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
09/01/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1280 CREEKSIDE ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34108-1948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-687-5600
Provider Business Mailing Address Fax Number:
239-687-5606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1280 CREEKSIDE ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34108-1948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-687-5600
Provider Business Practice Location Address Fax Number:
239-687-5606
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  ME111333 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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