Healthcare Provider Details

I. General information

NPI: 1457366502
Provider Name (Legal Business Name): ALEJANDRO RESTREPO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BAYOU BLVD STE 6
PENSACOLA FL
32503-1901
US

IV. Provider business mailing address

4700 BAYOU BLVD STE 6
PENSACOLA FL
32503-1901
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-9253
  • Fax: 850-494-9843
Mailing address:
  • Phone: 850-477-9253
  • Fax: 850-494-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberP4803
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberP4803
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME157716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: