Healthcare Provider Details

I. General information

NPI: 1770907743
Provider Name (Legal Business Name): JOAQUIN S MAURY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 SW 117TH AVE STE 416
MIAMI FL
33183-4828
US

IV. Provider business mailing address

8200 SW 117TH AVE STE 416
MIAMI FL
33183-4828
US

V. Phone/Fax

Practice location:
  • Phone: 786-409-7662
  • Fax: 786-409-5881
Mailing address:
  • Phone: 786-409-7662
  • Fax: 786-409-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME117409
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME117409
License Number StateFL

VIII. Authorized Official

Name: JOAQUIN S MAURY
Title or Position: MD
Credential:
Phone: 305-702-9441