Healthcare Provider Details

I. General information

NPI: 1831256882
Provider Name (Legal Business Name): JOSE M TEXIDOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 12TH ST SUITE 311
KEY WEST FL
33040-4088
US

IV. Provider business mailing address

1111 12TH ST SUITE 311
KEY WEST FL
33040-4088
US

V. Phone/Fax

Practice location:
  • Phone: 305-295-6700
  • Fax: 305-295-6700
Mailing address:
  • Phone: 305-295-6700
  • Fax: 305-295-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA074267
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 125918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: