Individual
MAURO JOSE TAVERAS ALCANTARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1609 W 40TH AVE STE 403, PINE BLUFF, AR 71603-6365
(870) 541-4285
(870) 541-4290
Mailing address
PO BOX 2650, PINE BLUFF, AR 71613-2650
(870) 541-7211
(870) 541-4297
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036.152621
IL
207RI0011X
Interventional Cardiology Physician
Primary
E-17813
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/15/2017
Last updated
06/18/2024
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