=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033699491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MD HEALTH PROVIDERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2018
-----------------------------------------------------
Last Update Date | 08/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3915 BISCAYNE BLVD STE 301
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-579-3916
-----------------------------------------------------
Fax | 954-239-3902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 DOCKSIDE LN STE 106
-----------------------------------------------------
City | KEY LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33037-5267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-579-3916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | HENRY ROJAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-579-3916
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME133533
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------