Provider Demographics
NPI:1851376883
Name:ALBOLIRAS, ERNERIO T (MD)
Entity Type:Individual
Prefix:MR
First Name:ERNERIO
Middle Name:T
Last Name:ALBOLIRAS
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 206289
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-6289
Mailing Address - Country:US
Mailing Address - Phone:480-756-6000
Mailing Address - Fax:480-467-2165
Practice Address - Street 1:9440 E IRONWOOD SQUARE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4569
Practice Address - Country:US
Practice Address - Phone:480-756-6000
Practice Address - Fax:480-467-2165
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360858192080P0202X
AZ357122080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085819 / 03Medicaid
AZ114574Medicaid
IL01621679OtherBCBS OF IL
ILE86687Medicare UPIN
E86687Medicare UPIN
IL036085819 / 03Medicaid
AZ114574Medicaid