MEDICARE: DR. DOUGLAS J INCIARTE 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	207Q00000X	Family Medicine Physician	ME107735	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

General Provider Information

NPI Number	:	1831304955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS J INCIARTE M.D

Provider Business Mailing Address
First Line	:	PO BOX 198054
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-8054
Country	:	US
Telephone Number	:	786-467-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	15955 SW 96TH ST STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-1272
Country	:	US
Telephone Number	:	786-467-3140
Fax Number	:	786-533-9276

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	01/10/2020

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