Individual
RIAS ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACC
Contact information
Practice address
4740 MILE STRETCH DR, HOLIDAY, FL 34690-4331
(727) 943-5200
(727) 943-5201
Mailing address
4740 MILE STRETCH DR, HOLIDAY, FL 34690-4331
(727) 943-5200
(727) 943-5201
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME83454
FL
207RI0011X
Interventional Cardiology Physician
Primary
ME83454
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13625
BCBS
FL
05
—
263856800
—
FL
Enumeration date
06/06/2006
Last updated
01/25/2019
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