Provider Demographics
NPI:1851352629
Name:JUNGREIS, ALEXANDER C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:C
Last Name:JUNGREIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5400 BROKEN SOUND BLVD NW
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3521
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-515-8865
Practice Address - Street 1:1693 LEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2260
Practice Address - Country:US
Practice Address - Phone:407-622-5766
Practice Address - Fax:407-622-5767
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54328174400000X, 208VP0014X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11947U FOR 34259AMedicare PIN
FLE83284Medicare UPIN
FL11947V FOR 34259Medicare PIN