Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ME122516 | FL |
NPI | 1013271881 |
---|---|
Provider Name | Dr. Adalberto Alfonso |
First Address | Lakeland, FL 33805-4543 |
Second Address | Lakeland, FL 33805-4543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2012 |
Last Update Date | 30/06/2015 |