Healthcare Provider Details

I. General information

NPI: 1295053593
Provider Name (Legal Business Name): JOSE GABRIEL MEDINA SMESTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BRICKELL AVE SUITE 954
MIAMI FL
33131-2951
US

IV. Provider business mailing address

801 BRICKELL AVE STE 900
MIAMI FL
33131-2979
US

V. Phone/Fax

Practice location:
  • Phone: 786-375-5098
  • Fax: 786-375-5033
Mailing address:
  • Phone: 786-477-4292
  • Fax: 786-574-5584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME117746
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberME117746
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberME117746
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME117746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: