MEDICARE: DR. EDWARD JOHN ALFREY 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	204F00000X	Transplant Surgery Physician	G72742	CA
2	204F00000X	Transplant Surgery Physician	036-114340	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992773311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JOHN ALFREY M.D.

Provider Business Mailing Address
First Line	:	5 BON AIR RD STE 101
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-1134
Country	:	US
Telephone Number	:	415-924-2515
Fax Number	:	415-924-2661

Provider Business Practice Location Address
First Line	:	5 BON AIR RD STE 101
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-1134
Country	:	US
Telephone Number	:	415-924-2515
Fax Number	:	415-924-2661

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	03/03/2026

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