Healthcare Provider Details

I. General information

NPI: 1528011087
Provider Name (Legal Business Name): MARIO ROBERTO PUTZEYS-ALVAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SE 17TH ST
OCALA FL
34471-4118
US

IV. Provider business mailing address

2020 SE 17TH ST
OCALA FL
34471-4118
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-0277
  • Fax: 352-861-1869
Mailing address:
  • Phone: 352-732-0277
  • Fax: 352-861-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME43678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: