Healthcare Provider Details

I. General information

NPI: 1841511797
Provider Name (Legal Business Name): JOSE M DONATIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 NW 5TH ST STE 204
PLANTATION FL
33317-2101
US

IV. Provider business mailing address

4161 NW 5TH ST STE 204
PLANTATION FL
33317-2101
US

V. Phone/Fax

Practice location:
  • Phone: 954-539-7557
  • Fax: 754-778-7995
Mailing address:
  • Phone: 954-539-7557
  • Fax: 754-778-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number88976
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: