Provider Demographics
NPI:1003842766
Name:PUJOL, ALFREDO G (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:G
Last Name:PUJOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 PALM AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4424
Mailing Address - Country:US
Mailing Address - Phone:305-822-8022
Mailing Address - Fax:305-826-0052
Practice Address - Street 1:4201 PALM AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4424
Practice Address - Country:US
Practice Address - Phone:305-822-8022
Practice Address - Fax:305-826-0052
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00448052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044997100Medicaid
FL044997100Medicaid
FL02645YMedicare PIN