Provider Demographics
NPI:1689866683
Name:PALACIO, ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:PALACIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDRES
Other - Middle Name:FILIPE
Other - Last Name:PALACIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3001 NW 49TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7263
Mailing Address - Country:US
Mailing Address - Phone:954-714-0684
Mailing Address - Fax:954-731-6017
Practice Address - Street 1:3001 NW 49TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7263
Practice Address - Country:US
Practice Address - Phone:954-714-0684
Practice Address - Fax:954-731-6017
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132797207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA056621OtherPHYSICIAN LICENSE