Healthcare Provider Details

I. General information

NPI: 1326039702
Provider Name (Legal Business Name): ELIAS N AMADOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

IV. Provider business mailing address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

V. Phone/Fax

Practice location:
  • Phone: 561-588-4844
  • Fax: 561-588-3655
Mailing address:
  • Phone: 561-588-4844
  • Fax: 561-588-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME76004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: