Healthcare Provider Details

I. General information

NPI: 1003899212
Provider Name (Legal Business Name): JOSE A LAVERGNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14505 COMMERCE WAY STE 800
MIAMI LAKES FL
33016-1599
US

IV. Provider business mailing address

9200 S DADELAND BLVD STE 800
MIAMI FL
33156-2758
US

V. Phone/Fax

Practice location:
  • Phone: 305-910-0408
  • Fax: 305-558-1500
Mailing address:
  • Phone: 786-530-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME90103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: