Provider Demographics
NPI:1215934435
Name:REGO, ALFREDO (MD)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:REGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3650 NW 82ND AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6658
Mailing Address - Country:US
Mailing Address - Phone:305-406-3596
Mailing Address - Fax:305-406-3599
Practice Address - Street 1:3650 NW 82ND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6658
Practice Address - Country:US
Practice Address - Phone:305-406-3596
Practice Address - Fax:305-406-3599
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2022-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME82945208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262590300Medicaid
FL262590300Medicaid
G99865Medicare UPIN