Healthcare Provider Details

I. General information

NPI: 1003087487
Provider Name (Legal Business Name): ALFREDO CESAR CORDOVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALFREDO CESAR CORDOVA DUPEYRAT M.D.

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST
SARASOTA FL
34239-2943
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-1579
  • Fax: 941-917-4340
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME129309
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number35139479
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: