Healthcare Provider Details

I. General information

NPI: 1760872519
Provider Name (Legal Business Name): ENRIQUE J CANTON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9360 SW 72ND ST SUITE 205
MIAMI FL
33173-5432
US

IV. Provider business mailing address

9360 SW 72ND ST SUITE 205
MIAMI FL
33173-5432
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME33195
License Number StateFL

VIII. Authorized Official

Name: DR. ENRIQUE J CANTON
Title or Position: PHYSICIAN
Credential:
Phone: 305-596-3100