Provider Demographics
NPI:1578901484
Name:VARA, ALEXANDER DOMINIC (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DOMINIC
Last Name:VARA
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 1:7100 W 20TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1813
Mailing Address - Country:US
Mailing Address - Phone:305-822-0401
Mailing Address - Fax:305-824-1748
Practice Address - Street 1:7100 W 20TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1813
Practice Address - Country:US
Practice Address - Phone:305-822-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103375207X00000X
IN01080568A207X00000X
FLME140023207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty