Healthcare Provider Details

I. General information

NPI: 1548407711
Provider Name (Legal Business Name): CORAL MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15053 S DIXIE HWY
MIAMI FL
33176-7930
US

IV. Provider business mailing address

15053 S DIXIE HWY
MIAMI FL
33176-7930
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-3434
  • Fax: 305-971-6393
Mailing address:
  • Phone: 305-251-3434
  • Fax: 305-971-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS10028
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME77599
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT M JAEGER
Title or Position: OWNER
Credential: DO
Phone: 305-251-3434