Provider Demographics
NPI:1326011784
Name:RUANGSOMBOON, ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:RUANGSOMBOON
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 1:1504 BAY RD
Mailing Address - Street 2:3204
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3268
Mailing Address - Country:US
Mailing Address - Phone:773-480-0629
Mailing Address - Fax:919-425-0468
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:954-462-5533
Practice Address - Fax:305-694-4810
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93802207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273518100Medicaid
FL28740AMedicare PIN