Provider Demographics
NPI:1093981912
Name:MELGAR, ALFREDO JORGE (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:JORGE
Last Name:MELGAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:ALFREDO
Other - Middle Name:J
Other - Last Name:DE MELGAR GARCIA DEL BUSTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8901 SW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4129
Mailing Address - Country:US
Mailing Address - Phone:305-848-3998
Mailing Address - Fax:305-489-7614
Practice Address - Street 1:9090 SW 87TH CT STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2317
Practice Address - Country:US
Practice Address - Phone:305-848-3998
Practice Address - Fax:305-489-7614
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1027962207R00000X
FLME102762208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000717700Medicaid