Provider Demographics
NPI:1376516880
Name:AGUIRRE, DOUGLAS EDWARD (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:AGUIRRE
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 1:2500 E HALLANDALE BEACH BLVD STE QR
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4834
Mailing Address - Country:US
Mailing Address - Phone:954-505-5009
Mailing Address - Fax:954-507-4486
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE QR
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4834
Practice Address - Country:US
Practice Address - Phone:954-505-5009
Practice Address - Fax:954-507-4486
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85167207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263683200Medicaid
FL17081XMedicare ID - Type Unspecified
H69111Medicare UPIN
FL17081ZMedicare ID - Type Unspecified
FL263683200Medicaid