Provider Demographics
NPI:1891771812
Name:ESPAILLAT, ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:ESPAILLAT
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 1:6233 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4022
Mailing Address - Country:US
Mailing Address - Phone:954-721-0000
Mailing Address - Fax:954-721-6308
Practice Address - Street 1:6233 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4022
Practice Address - Country:US
Practice Address - Phone:954-721-0000
Practice Address - Fax:954-721-6308
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101886300Medicaid
207W00000XOtherTAXONOMY CODE
FL101886300Medicaid
E5584TOtherPTAN
449-9224OtherECFMG
FLME81887OtherMEDICAL LICENSE
10727084OtherCAQH
E5584TOtherPTAN
H37912Medicare UPIN