Healthcare Provider Details

I. General information

NPI: 1760479943
Provider Name (Legal Business Name): JOSE K AZARET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11880 BIRD RD STE 319
MIAMI FL
33175-3584
US

IV. Provider business mailing address

11880 BIRD RD STE 319
MIAMI FL
33175-3584
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-6260
  • Fax: 305-220-1258
Mailing address:
  • Phone: 305-551-6260
  • Fax: 305-220-1258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0027866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: