Provider Demographics
NPI:1104873504
Name:ALARCON, EDUARDO J (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:J
Last Name:ALARCON
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 1:4960 SW 72ND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5549
Mailing Address - Country:US
Mailing Address - Phone:305-479-2393
Mailing Address - Fax:330-584-7373
Practice Address - Street 1:4960 SW 72ND AVE STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5549
Practice Address - Country:US
Practice Address - Phone:305-479-2393
Practice Address - Fax:305-847-3737
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44378208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME44378OtherMEDICAL LICENSE
FL049797500Medicaid
FL497975000Medicaid
FL96703XMedicare PIN
FLME44378OtherMEDICAL LICENSE