MEDICARE: JOSE L PONCE DE LEON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	ME0090684	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215962261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE L PONCE DE LEON M.D.

Provider Business Mailing Address
First Line	:	3501 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3634
Country	:	US
Telephone Number	:	305-229-1227
Fax Number	:	305-229-0527

Provider Business Practice Location Address
First Line	:	3501 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3634
Country	:	US
Telephone Number	:	305-229-1227
Fax Number	:	305-229-0527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/10/2012

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