Individual
DR. RENATO A ALFONSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
84 PINNACLES DR, SUITE #200, PALM COAST, FL 32164-2324
(386) 439-9777
(386) 206-0015
Mailing address
84 PINNACLES DR, SUITE #200, PALM COAST, FL 32164-2324
(386) 439-9777
(386) 206-0015
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME69077
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253950100
—
FL
Enumeration date
09/16/2005
Last updated
01/29/2010
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