Healthcare Provider Details

I. General information

NPI: 1164476313
Provider Name (Legal Business Name): GREGORY J ALFRED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW 40TH ST KENDALL REGIONAL MEDICAL CENTER EMERGENCY DEPT
MIAMI FL
33175-3530
US

IV. Provider business mailing address

420 NE 88TH ST
EL PORTAL FL
33138-3143
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-5544
  • Fax:
Mailing address:
  • Phone: 305-812-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA79311
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME99486
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME99486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: