Healthcare Provider Details

I. General information

NPI: 1326011784
Provider Name (Legal Business Name): ALVIN RUANGSOMBOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW 95TH ST
MIAMI FL
33150-2038
US

IV. Provider business mailing address

1504 BAY RD 3204
MIAMI BEACH FL
33139-3268
US

V. Phone/Fax

Practice location:
  • Phone: 954-462-5533
  • Fax: 305-694-4810
Mailing address:
  • Phone: 773-480-0629
  • Fax: 919-425-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME93802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: