MEDICARE: DONALD JOHN ALEXANDER DDS

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
1	122300000X	Dentist	DN14816	FL

General Provider Information

NPI Number	:	1508135153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD JOHN ALEXANDER DDS

Provider Business Mailing Address
First Line	:	6802 SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2818
Country	:	US
Telephone Number	:	904-551-3861
Fax Number	:

Provider Business Practice Location Address
First Line	:	6802 SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2818
Country	:	US
Telephone Number	:	904-551-3861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	12/27/2011

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