Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301080202 | MI |
Y | 208600000X | Surgeon | 4301080202 | MI |
N | 2086S0122X | Plastic and Reconstructive Surgery | 4301080202 | MI |
NPI | 1093930190 |
---|---|
Provider Name | Dr. David R Alfonso |
First Address | Grand Rapids, MI 49503-2208 |
Second Address | Grand Rapids, MI 49503-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 20/11/2018 |