1316196512 NPI number — DR. ALFRED JOHN COLFRY III M.D.

Table of content: DR. ALFRED JOHN COLFRY III M.D. (NPI 1316196512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316196512 NPI number — DR. ALFRED JOHN COLFRY III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLFRY
Provider First Name:
ALFRED
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316196512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 PRYTANIA ST
Provider Second Line Business Mailing Address:
STE. 35, CRESCENT CITY PHYSICIANS, INC.
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70115-3628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-897-7197
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3434 PRYTANIA ST
Provider Second Line Business Practice Location Address:
STE. 320, CRESCENT CITY PHYSICIANS, INC.
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70115-3572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-897-7142
Provider Business Practice Location Address Fax Number:
504-210-4286
Provider Enumeration Date:
09/11/2008

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: 282N00000X , with the licence number:  003300 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: Q0027 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 338942101 (MDACC) , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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