Healthcare Provider Details

I. General information

NPI: 1699568840
Provider Name (Legal Business Name): ALEXANDER BOLUFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

76 UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 954-559-6781
  • Fax:
Mailing address:
  • Phone: 954-559-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN42323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: