Provider Demographics
NPI:1275538894
Name:JARQUIN, ALVARO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:JOSE
Last Name:JARQUIN
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 1:4404 S FLORIDA AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2169
Mailing Address - Country:US
Mailing Address - Phone:863-937-9148
Mailing Address - Fax:863-937-9653
Practice Address - Street 1:4404 S FLORIDA AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2169
Practice Address - Country:US
Practice Address - Phone:863-937-9148
Practice Address - Fax:863-937-9653
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257915400Medicaid
FL257915400Medicaid
H06871Medicare UPIN