Healthcare Provider Details

I. General information

NPI: 1396249637
Provider Name (Legal Business Name): SEASIDE PEDIATRICS OF KEY WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WHITE ST STE 103
KEY WEST FL
33040-3328
US

IV. Provider business mailing address

1201 WHITE ST STE 103
KEY WEST FL
33040-3328
US

V. Phone/Fax

Practice location:
  • Phone: 305-295-7337
  • Fax: 305-295-0597
Mailing address:
  • Phone: 305-295-7337
  • Fax: 305-295-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME125918
License Number StateFL

VIII. Authorized Official

Name: DR. JOSE TEXIDOR
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-295-7337