Provider Demographics
NPI:1174524789
Name:ALPERN, JEFFREY BARTON (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BARTON
Last Name:ALPERN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21579 N 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6287
Mailing Address - Country:US
Mailing Address - Phone:610-737-4445
Mailing Address - Fax:623-428-0069
Practice Address - Street 1:21579 N 56TH AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6287
Practice Address - Country:US
Practice Address - Phone:610-737-4445
Practice Address - Fax:623-428-0069
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3749208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010425420010Medicaid
AZP00244441OtherRAILROAD MEDICARE
AZ825961Medicaid
PA0010425420010Medicaid