Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME 96070 | FL |
N | 208600000X | Surgeon | ME 96070 | FL |
Y | 2086X0206X | Surgical Oncologist | ME 96070 | FL |
NPI | 1104913532 |
---|---|
Provider Name | Matthew Jon D'alessio |
First Address | Delray Beach, FL 33444-4034 |
Second Address | Delray Beach, FL 33444-4034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 09/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036119388 | (05) | IL |
I38738 | (02) | FL |
P00472576 | RAILROAD MEDICARE (01) | IL |