1700057916 NPI number — FERNANDO ALEGRIA, MD, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700057916 NPI number — FERNANDO ALEGRIA, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FERNANDO ALEGRIA, MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1700057916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEMOPOLIS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36732-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-289-3755
Provider Business Mailing Address Fax Number:
334-289-3766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 US HIGHWAY 80 E
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
DEMOPOLIS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36732-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-289-3755
Provider Business Practice Location Address Fax Number:
334-289-3766
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ALEGRIA
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/SURGEON
Authorized Official Telephone Number:
334-289-3755

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  25440 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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