Healthcare Provider Details

I. General information

NPI: 1699890616
Provider Name (Legal Business Name): ALFREDO GUZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 ALI WAY
OXFORD AL
36203-1835
US

IV. Provider business mailing address

909 BOSWELL DR
OXFORD AL
36203-2213
US

V. Phone/Fax

Practice location:
  • Phone: 256-832-4141
  • Fax: 256-832-4153
Mailing address:
  • Phone: 334-718-0862
  • Fax: 256-832-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12483
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: