MEDICARE: DR. JOSE CRESPIN MD

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	207Q00000X	Family Medicine Physician	ME60672	FL

General Provider Information

NPI Number	:	1568419687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE CRESPIN MD

Provider Business Mailing Address
First Line	:	2500 SW 107TH AVE
Second Line	:	STE 46/47
City	:	MIAMI
State	:	FL
Zip	:	33165-2470
Country	:	US
Telephone Number	:	305-228-9601
Fax Number	:	305-228-6742

Provider Business Practice Location Address
First Line	:	2500 SW 107TH AVE
Second Line	:	STE 46/47
City	:	MIAMI
State	:	FL
Zip	:	33165-2470
Country	:	US
Telephone Number	:	305-228-9601
Fax Number	:	305-228-6742

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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