Provider Demographics
NPI:1831117092
Name:ALDANA, PHILIPP ROQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIPP
Middle Name:ROQUE
Last Name:ALDANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:UFJP PEDIATRIC NEUROSURGERY CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-398-5201
Practice Address - Fax:904-398-8838
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME70228207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA343260232AMedicaid
FL2760070-00Medicaid
FLI19810Medicare UPIN
GA343260232AMedicaid
FLU8082ZMedicare PIN