Provider Demographics
NPI:1427095959
Name:JEREZ, ALVARO J (MD)
Entity type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:J
Last Name:JEREZ
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 1:14012 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3001
Mailing Address - Country:US
Mailing Address - Phone:786-703-6884
Mailing Address - Fax:786-703-5591
Practice Address - Street 1:14012 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3001
Practice Address - Country:US
Practice Address - Phone:786-703-6884
Practice Address - Fax:786-703-5591
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
04089Medicare ID - Type Unspecified
FLD20876Medicare UPIN