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General NPI Number Information
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NPI Number | 1013983402
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Entity Type | Individual
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Provider Name | JORGE A ALFONSO MD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 495 STATION AVE
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City | SOUTH YARMOUTH
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State | MA
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Zip | 02664-1218
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Country | US
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Telephone | 508-778-4777
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Fax | 508-771-9555
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Provider Business Mailing Address
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Address Line | 297 NORTH ST STE 221
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City | HYANNIS
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State | MA
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Zip | 02601-5133
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Country | US
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Telephone | 508-862-7777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 223490
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License Number State | MA
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