Healthcare Provider Details

I. General information

NPI: 1679747067
Provider Name (Legal Business Name): ERIC JOAQUIN BALAGUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 SW 87TH AVE SUITE 100
MIAMI FL
33176-2227
US

IV. Provider business mailing address

8905 SW 87 AVENUE SUITE 100
MIAMI FL
33176-2210
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-8686
  • Fax: 305-667-8680
Mailing address:
  • Phone: 305-667-8686
  • Fax: 305-270-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME108747
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number253066
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number047689
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: