Healthcare Provider Details

I. General information

NPI: 1346572138
Provider Name (Legal Business Name): JUAN R. BOLET, M.D.P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PURDY AVE APT. 1408
MIAMI BEACH FL
33139-1465
US

IV. Provider business mailing address

1800 PURDY AVE APT. 1408
MIAMI BEACH FL
33139-1465
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-4153
  • Fax: 786-275-6990
Mailing address:
  • Phone: 305-856-4153
  • Fax: 786-275-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13524
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN R BOLET
Title or Position: PRESIDENT
Credential: MD
Phone: 305-856-4153