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General NPI Number Information
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NPI Number | 1700087251
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Entity Type | Individual
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Provider Name | ALEJANDRO JOSE LUIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 02/15/2026
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Provider Practice Location Address
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Address Line | 1703 LEWIS TURNER BLVD
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1221
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Country | US
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Telephone | 850-864-4033
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3413
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-3413
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Country | US
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Telephone | 850-864-4033
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Fax | 850-864-4076
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18181
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | LL 29082
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License Number State | SC
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