Provider Demographics
NPI:1922216464
Name:VISBAL, ALVARO EFRAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:EFRAIN
Last Name:VISBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALVARO
Other - Middle Name:EFRAIN
Other - Last Name:VISBAL VENTURA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-265-9976
Practice Address - Fax:954-965-5396
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101129207RP1001X, 207RC0200X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001826300Medicaid
FLCR601WOtherMEDICARE PTAN