Healthcare Provider Details

I. General information

NPI: 1679593917
Provider Name (Legal Business Name): ALEJANDRO G TAPIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 MEDICAL PARK BLVD STE 460
WELLINGTON FL
33414-3188
US

IV. Provider business mailing address

PO BOX 310754 DEPT 4101
BOCA RATON FL
33431-0754
US

V. Phone/Fax

Practice location:
  • Phone: 561-472-5811
  • Fax: 561-472-5811
Mailing address:
  • Phone: 561-255-3131
  • Fax: 561-622-4324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME94437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: