Provider Demographics
NPI:1366741746
Name:AZUERO, MARIO ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ANDRES
Last Name:AZUERO
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:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:953 E DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6669
Practice Address - Country:US
Practice Address - Phone:813-634-6880
Practice Address - Fax:813-634-6833
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7803207Q00000X
FLME128374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5TT56OtherBLUE CROSS BLUE SHIELD
FLMD454OtherMCR