Provider Demographics
NPI:1306821590
Name:ENRIQUEZ, ALBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:J
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1920 DON WICKHAM DR STE 127
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1978
Mailing Address - Country:US
Mailing Address - Phone:352-536-8807
Mailing Address - Fax:352-536-8819
Practice Address - Street 1:1920 DON WICKHAM DR STE 127
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1978
Practice Address - Country:US
Practice Address - Phone:352-536-8807
Practice Address - Fax:352-536-8819
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32133207VF0040X, 207VG0400X
FLME133507207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00914343OtherRR MEDICARE
FL023047800Medicaid