Provider Demographics
NPI:1275526097
Name:CALLEJAS, ALEJANDRO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
Last Name:CALLEJAS
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 1:2525 HARBOR BLVD
Mailing Address - Street 2:203
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5317
Mailing Address - Country:US
Mailing Address - Phone:941-627-9119
Mailing Address - Fax:941-627-3011
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:203
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:941-627-9119
Practice Address - Fax:941-627-3011
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043036208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08126OtherBCBS
FL068716200Medicaid
FL068716200Medicaid
FL020004578Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FL08126Medicare ID - Type Unspecified