MEDICARE: DR. ALBERT J ENRIQUEZ MD

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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	32133	MN
2	207VG0400X	Gynecology Physician	32133	MN
3	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	ME133507	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00914343	OTHER	MN	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1306821590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT J ENRIQUEZ MD

Provider Business Mailing Address
First Line	:	1920 DON WICKHAM DR STE 127
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-1978
Country	:	US
Telephone Number	:	352-536-8807
Fax Number	:	352-536-8819

Provider Business Practice Location Address
First Line	:	1920 DON WICKHAM DR STE 127
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-1978
Country	:	US
Telephone Number	:	352-536-8807
Fax Number	:	352-536-8819

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	10/17/2018

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Directions to “ DR. ALBERT J ENRIQUEZ MD” Practice Location

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