MEDICARE: JOHN EDWARD ALEXANDER 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
1	2085R0202X	Diagnostic Radiology Physician	55889	MA
2	2085R0202X	Diagnostic Radiology Physician	18645	NH

General Provider Information

NPI Number	:	1689600652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN EDWARD ALEXANDER M.D.

Provider Business Mailing Address
First Line	:	11995 SINGLETREE LN
Second Line	:	SUITE 500
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-5347
Country	:	US
Telephone Number	:	952-595-1301
Fax Number	:	612-294-4903

Provider Business Practice Location Address
First Line	:	53 GREGG MILL RD
Second Line	:
City	:	NEW BOSTON
State	:	NH
Zip	:	03070-3746
Country	:	US
Telephone Number	:	952-595-1100
Fax Number	:	612-294-4903

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	02/16/2018

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