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General NPI Number Information
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NPI Number | 1598949828
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Entity Type | Organization
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Legal Business Name | JORDAN & PRIETO PA
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 4302 W BROWARD BLVD STE 200
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City | PLANTATION
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State | FL
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Zip | 33317-3700
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Country | US
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Telephone | 954-583-0778
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Fax | 954-583-8140
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Provider Business Mailing Address
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Address Line | 4302 W BROWARD BLVD STE 200
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City | PLANTATION
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State | FL
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Zip | 33317-3700
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Country | US
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Telephone | 954-583-0778
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Fax | 954-583-8140
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OCTAVIO ENRIQUE PRIETO
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Credential | M.D,
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Telephone | 954-583-0778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME34072
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License Number State | FL
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