Provider Demographics
NPI:1134320880
Name:BUITRAGO, EFREN (MD)
Entity Type:Individual
Prefix:DR
First Name:EFREN
Middle Name:
Last Name:BUITRAGO
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 1:3650 NW 82ND AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6658
Mailing Address - Country:US
Mailing Address - Phone:305-406-3596
Mailing Address - Fax:305-406-3599
Practice Address - Street 1:3650 NW 82ND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6658
Practice Address - Country:US
Practice Address - Phone:305-406-3596
Practice Address - Fax:305-406-3599
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 92356208600000X
FLME923562086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000215400Medicaid
FL000215400Medicaid