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NPI Code Detail

MEDICARE: DR. ALEXANDER DEJESUS M.D.

MEDICARE: DR. ALEXANDER DEJESUS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation PhysicianME0077137FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1250011263OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
344664OTHERFLBCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184772667
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALEXANDER DEJESUS M.D.
Provider Business Mailing Address
First Line : PO BOX 4898
Second Line :
City : WINTER PARK
State : FL
Zip : 32793-4898
Country : US
Telephone Number : 407-681-2241
Fax Number :
Provider Business Practice Location Address
First Line : 6400 EDGELAKE DR
Second Line :
City : SARASOTA
State : FL
Zip : 34240-8813
Country : US
Telephone Number : 941-921-8645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/14/2022

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