Healthcare Provider Details

I. General information

NPI: 1215923966
Provider Name (Legal Business Name): JOHN ESIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 NW 136TH AVE #200
SUNRISE FL
33323-2853
US

IV. Provider business mailing address

PO BOX 452169
SUNRISE FL
33345-2169
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME93644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: