MEDICARE: SOUTHERN MARKET DISTRIBUTORS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1467402677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN MARKET DISTRIBUTORS

Provider Business Mailing Address
First Line	:	12924 SW 133 COURT
Second Line	:	SUITE C
City	:	MIAMI
State	:	FL
Zip	:	33186
Country	:	US
Telephone Number	:	786-444-8426
Fax Number	:

Provider Business Practice Location Address
First Line	:	4645 EAST 9 COURT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013
Country	:	US
Telephone Number	:	786-444-8426
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALFREDO SUAREZ
Credential	:
Telephone Number	:	786-444-8426

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/22/2020

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