MEDICARE: DR. LOUIDOR ALLIANCE M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	18107	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043513930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIDOR ALLIANCE M.D

Provider Business Mailing Address
First Line	:	850 S 21ST ST
Second Line	:	STE B
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4829
Country	:	US
Telephone Number	:	561-951-7074
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 GAZETTA WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1052
Country	:	US
Telephone Number	:	561-951-7074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	09/28/2016

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