Healthcare Provider Details

I. General information

NPI: 1740264761
Provider Name (Legal Business Name): ALPHONSE R TRIBUIANI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 CORKSCREW RD STE 7
ESTERO FL
33928-3216
US

IV. Provider business mailing address

9250 CORKSCREW RD STE 7
ESTERO FL
33928-3216
US

V. Phone/Fax

Practice location:
  • Phone: 239-949-2121
  • Fax: 239-597-5388
Mailing address:
  • Phone: 239-949-2121
  • Fax: 239-597-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP02858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: