Healthcare Provider Details

I. General information

NPI: 1265453286
Provider Name (Legal Business Name): ALEXANDER MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12416 66TH STREET N SUITE A
LARGO FL
33773-3437
US

IV. Provider business mailing address

12416 66TH ST
LARGO FL
33773-3437
US

V. Phone/Fax

Practice location:
  • Phone: 727-547-4700
  • Fax: 727-394-8661
Mailing address:
  • Phone: 727-547-4700
  • Fax: 727-394-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME 77329
License Number StateFL

VIII. Authorized Official

Name: SHERRY JACKASAL-LABONTE
Title or Position: OFFICE MANAGER
Credential:
Phone: 727-547-4700