Healthcare Provider Details

I. General information

NPI: 1477586204
Provider Name (Legal Business Name): EDGARD A NUNEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/03/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W MOWRY DR
HOMESTEAD FL
33030-5746
US

IV. Provider business mailing address

810 W MOWRY DR
HOMESTEAD FL
33030-5746
US

V. Phone/Fax

Practice location:
  • Phone: 305-242-6015
  • Fax: 305-245-1161
Mailing address:
  • Phone: 305-242-6015
  • Fax: 305-245-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME84491
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME84491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: