Provider Demographics
NPI:1003087487
Name:CORDOVA, ALFREDO CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:CESAR
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALFREDO
Other - Middle Name:CESAR
Other - Last Name:CORDOVA DUPEYRAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-1579
Practice Address - Fax:941-917-4340
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129309208600000X
OH351394792086S0102X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0409364Medicaid
FLM5X8WOtherBCBS OF FL
FLIR175ZMedicare PIN