Provider Demographics
NPI:1265637078
Name:AMOAKO, ALEX (PA)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:AMOAKO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W 46TH ST
Mailing Address - Street 2:#715
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2836
Mailing Address - Country:US
Mailing Address - Phone:305-733-2286
Mailing Address - Fax:
Practice Address - Street 1:3804 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-6232
Practice Address - Country:US
Practice Address - Phone:305-624-2700
Practice Address - Fax:305-624-3154
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant