Healthcare Provider Details

I. General information

NPI: 1609863000
Provider Name (Legal Business Name): DAVID A ALCINDOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57950 LEAVENWORTH ST 22 MDG SGQ
MCCONNELL AFB KS
67221-3506
US

IV. Provider business mailing address

57950 LEAVENWORTH ST 22 MDG SGQ
MCCONNELL AFB KS
67221-3506
US

V. Phone/Fax

Practice location:
  • Phone: 316-759-5864
  • Fax: 316-759-5038
Mailing address:
  • Phone: 316-759-5864
  • Fax: 316-759-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-30794
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0430794
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: