Provider Demographics
NPI:1043513930
Name:ALLIANCE, LOUIDOR (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIDOR
Middle Name:
Last Name:ALLIANCE
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 1:850 S 21ST ST
Mailing Address - Street 2:STE B
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4829
Mailing Address - Country:US
Mailing Address - Phone:561-951-7074
Mailing Address - Fax:
Practice Address - Street 1:424 GAZETTA WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33413-1052
Practice Address - Country:US
Practice Address - Phone:561-951-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18107208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice