Provider Demographics
NPI:1073591483
Name:VALDES, IGNACIO L (MD)
Entity Type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:L
Last Name:VALDES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3467 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9473
Mailing Address - Country:US
Mailing Address - Phone:954-420-0886
Mailing Address - Fax:954-420-0964
Practice Address - Street 1:3467 W HILLSBORO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9473
Practice Address - Country:US
Practice Address - Phone:954-420-0886
Practice Address - Fax:954-420-0964
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG58877Medicare UPIN
FL41451AMedicare ID - Type Unspecified