Provider Demographics
NPI:1730171125
Name:IRIBAR, MANUEL RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:RAFAEL
Last Name:IRIBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:IRIBAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3702 WASHINGTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8283
Mailing Address - Country:US
Mailing Address - Phone:954-926-2900
Mailing Address - Fax:954-926-2956
Practice Address - Street 1:3702 WASHINGTON ST STE 205
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8283
Practice Address - Country:US
Practice Address - Phone:954-926-2900
Practice Address - Fax:954-926-2956
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2024-08-23
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-05-02
Provider Licenses
StateLicense IDTaxonomies
FLME41495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0681156Medicaid
FLD57200Medicare UPIN
FL61340Medicare PIN