Provider Demographics
NPI:1194794438
Name:ALONSO, RAUL (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:ALONSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:15476 NW 77TH CT
Mailing Address - Street 2:# 708
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5823
Mailing Address - Country:US
Mailing Address - Phone:305-824-5517
Mailing Address - Fax:305-556-6005
Practice Address - Street 1:290 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3763
Practice Address - Country:US
Practice Address - Phone:305-824-5517
Practice Address - Fax:305-556-6005
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0072859207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254469501Medicaid
FL254469501Medicaid
FLH06520Medicare UPIN