Provider Demographics
NPI:1932323250
Name:SOCARRAS, LUIS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:SOCARRAS
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 69
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-0069
Mailing Address - Country:US
Mailing Address - Phone:561-766-1200
Mailing Address - Fax:561-932-0997
Practice Address - Street 1:672 SW PRIMA VISTA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1820
Practice Address - Country:US
Practice Address - Phone:772-905-2555
Practice Address - Fax:561-766-1210
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32265207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036420700Medicaid
FL036420700Medicaid
FL17457Medicare ID - Type Unspecified