Provider Demographics
NPI:1194159749
Name:LUIS DUHARTE AND ASSOCIATES MD LLC
Entity type:Organization
Organization Name:LUIS DUHARTE AND ASSOCIATES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUHARTE VIDAURRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-314-0004
Mailing Address - Street 1:4409 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2170
Mailing Address - Country:US
Mailing Address - Phone:863-314-0004
Mailing Address - Fax:863-314-0944
Practice Address - Street 1:4409 SUN N LAKE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2170
Practice Address - Country:US
Practice Address - Phone:863-314-0004
Practice Address - Fax:863-314-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95160207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty