Provider Demographics
NPI:1912278946
Name:EUGENIO E FIALLOS MD PA
Entity type:Organization
Organization Name:EUGENIO E FIALLOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-559-2173
Mailing Address - Street 1:12451 SW 21ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7708
Mailing Address - Country:US
Mailing Address - Phone:305-559-2173
Mailing Address - Fax:
Practice Address - Street 1:12451 SW 21ST LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7708
Practice Address - Country:US
Practice Address - Phone:305-559-2173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME360542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245379577OtherNPI TYPE 1
FL95432Medicare PIN