Provider Demographics
NPI:1093981912
Name:MELGAR, ALFREDO JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:JORGE
Last Name:MELGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALFREDO
Other - Middle Name:J
Other - Last Name:DE MELGAR GARCIA DEL BUSTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8275 SW 93RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7358
Mailing Address - Country:US
Mailing Address - Phone:305-401-0441
Mailing Address - Fax:305-223-2438
Practice Address - Street 1:10000 SW 56TH ST STE 17
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7162
Practice Address - Country:US
Practice Address - Phone:305-223-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102762208D00000X
FLME1027962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000717700Medicaid