Provider Demographics
NPI:1376588061
Name:DALLY, ALFREDO DEJESUS (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:DEJESUS
Last Name:DALLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13992 LAKE GEORGE CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3043
Mailing Address - Country:US
Mailing Address - Phone:305-269-8099
Mailing Address - Fax:305-261-3250
Practice Address - Street 1:5511 SW 8TH ST STE 101
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2272
Practice Address - Country:US
Practice Address - Phone:305-269-8099
Practice Address - Fax:305-261-3250
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2024-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME88433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273896100Medicaid
FLU1357ZMedicare ID - Type Unspecified