Provider Demographics
NPI:1629091210
Name:NARVAEZ, ADOLFO LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:LEON
Last Name:NARVAEZ
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:PO BOX 14520
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34280-4520
Mailing Address - Country:US
Mailing Address - Phone:941-795-4206
Mailing Address - Fax:941-795-1386
Practice Address - Street 1:5591 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2818
Practice Address - Country:US
Practice Address - Phone:941-795-4206
Practice Address - Fax:941-795-1386
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115975OtherAMERIGROUP
FL2111737OtherAETNA
FL048923901Medicaid
FL19889OtherWELLCARE
FL2111737OtherAETNA
FL115975OtherAMERIGROUP