Individual
DR. ALFONSO PUERTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10806 WARD AVE, LOUISVILLE, KY 40223-2659
(502) 899-1246
(502) 899-1292
Mailing address
PO BOX 436809, LOUISVILLE, KY 40253-6809
(502) 899-1246
(502) 899-1292
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
LL339
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012087671
RAILROAD MEDICARE
KY
01
—
1059063
PASSPORT HEALTHPLAN
KY
05
—
64993397
—
KY
01
—
P100031756
MEDICARE PAY TO PROVIDER NUMBER
KY
01
—
P400031727
MEDICARE PERFORMING PROVIDER NUMBER
KY
Enumeration date
06/14/2006
Last updated
12/07/2011
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