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NPI Code Detail

MEDICARE: DR. JOSE ANGEL MAYORQUIN M.D.

MEDICARE: DR. JOSE ANGEL MAYORQUIN 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
1207Q00000XFamily Medicine Physician28875NE
2207Q00000XFamily Medicine Physician7173NE

General Provider Information

NPI Number : 1881009884
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE ANGEL MAYORQUIN M.D.
Provider Business Mailing Address
First Line : 7261 MERCY RD
Second Line :
City : OMAHA
State : NE
Zip : 68124-2311
Country : US
Telephone Number : 402-733-4433
Fax Number : 402-733-1220
Provider Business Practice Location Address
First Line : 4220 L ST
Second Line :
City : OMAHA
State : NE
Zip : 68107-1048
Country : US
Telephone Number : 402-733-4433
Fax Number : 402-733-1220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2014
Last Update Date : 07/14/2017

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Directions to “ DR. JOSE ANGEL MAYORQUIN M.D.” Practice Location

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