Basic Information
| Provider Information | |||||||||
| NPI: | 1427004548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOSDOS | ||||||||
| FirstName: | ALFREDO | ||||||||
| MiddleName: | REYES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 JFK DR | ||||||||
| Address2: | STE B | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612956962 | ||||||||
| FaxNumber: | 5612492512 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 S CONGRESS AVE | ||||||||
| Address2: | # 201 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616417848 | ||||||||
| FaxNumber: | 5616416985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME55592 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 61828400 | 05 | FL | MEDICAID |