Healthcare Provider Details

I. General information

NPI: 1689905424
Provider Name (Legal Business Name): ANTHONY WAYNE ALGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COST GUARD ISLAND BUILDING 1
ALAMEDA CA
94501
US

IV. Provider business mailing address

912 CENTENNIAL AVE UNIT. B
ALAMEDA CA
94501-3979
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-3827
  • Fax:
Mailing address:
  • Phone: 949-275-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: