Healthcare Provider Details

I. General information

NPI: 1710175526
Provider Name (Legal Business Name): LUIS ENRIQUE PURON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SW 152ND ST
MIAMI FL
33177-1111
US

IV. Provider business mailing address

6200 SUNSET DR STE 302
SOUTH MIAMI FL
33143-4829
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-4300
  • Fax:
Mailing address:
  • Phone: 786-888-8820
  • Fax: 786-591-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2006-0755
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME97466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: