MEDICARE: GREGORY J ALFRED M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	A79311	CA
2	207P00000X	Emergency Medicine Physician	ME99486	FL
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	ME99486	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164476313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY J ALFRED M.D.

Provider Business Mailing Address
First Line	:	420 NE 88TH ST
Second Line	:
City	:	EL PORTAL
State	:	FL
Zip	:	33138-3143
Country	:	US
Telephone Number	:	305-812-5206
Fax Number	:

Provider Business Practice Location Address
First Line	:	11750 SW 40TH ST
Second Line	:	KENDALL REGIONAL MEDICAL CENTER EMERGENCY DEPT
City	:	MIAMI
State	:	FL
Zip	:	33175-3530
Country	:	US
Telephone Number	:	305-227-5544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/25/2024

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