Provider Demographics
NPI:1871737114
Name:ALONSO, MANUEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:P
Last Name:ALONSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 LAKE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-1755
Mailing Address - Country:US
Mailing Address - Phone:352-589-5646
Mailing Address - Fax:
Practice Address - Street 1:1733 LAKE TERRACE DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-1755
Practice Address - Country:US
Practice Address - Phone:352-589-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43298207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96617Medicare PIN