Provider Demographics
NPI:1245379577
Name:FIALLOS, EUGENIO E
Entity Type:Individual
Prefix:DR
First Name:EUGENIO
Middle Name:E
Last Name:FIALLOS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:EUGENIO
Other - Middle Name:E
Other - Last Name:FIALLOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12451 SW 21ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7708
Mailing Address - Country:US
Mailing Address - Phone:305-559-2173
Mailing Address - Fax:
Practice Address - Street 1:12260 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1551
Practice Address - Country:US
Practice Address - Phone:305-559-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 360542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95432Medicare ID - Type Unspecified