Healthcare Provider Details

I. General information

NPI: 1508815002
Provider Name (Legal Business Name): ALFRED JOSEPH TECTOR M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW 9TH AVE
MIAMI FL
33136-1101
US

IV. Provider business mailing address

1801 NW 9TH AVE
MIAMI FL
33136-1101
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-5760
  • Fax: 305-355-5793
Mailing address:
  • Phone: 305-355-5760
  • Fax: 305-355-5793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number35090
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number01054551A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME141696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: