Provider Demographics
NPI:1528011087
Name:PUTZEYS-ALVAREZ, MARIO ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ROBERTO
Last Name:PUTZEYS-ALVAREZ
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 1:2020 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4118
Mailing Address - Country:US
Mailing Address - Phone:352-732-0277
Mailing Address - Fax:352-861-1869
Practice Address - Street 1:2020 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4118
Practice Address - Country:US
Practice Address - Phone:352-732-0277
Practice Address - Fax:352-861-1869
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
D08965Medicare UPIN
FL37491ZMedicare ID - Type Unspecified