Provider Demographics
NPI:1215924196
Name:PORTUGAL, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:PORTUGAL
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 1:5996 SW 70TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3540
Mailing Address - Country:US
Mailing Address - Phone:305-284-7577
Mailing Address - Fax:305-284-7688
Practice Address - Street 1:7000 SW 62ND AVE STE 600
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4728
Practice Address - Country:US
Practice Address - Phone:305-284-7577
Practice Address - Fax:305-284-7688
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ68146207L00000X
FLME116362207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4574605Medicaid
NJ050063505OtherRAIL ROAD MEDICARE
NJ050063505OtherRAIL ROAD MEDICARE
NJ4574605Medicaid