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NPI Code Detail

MEDICARE: JOSE E JAEN M.D.

MEDICARE:   JOSE E JAEN  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME38391FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
196800VOTHERFLMEDICARE ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063436046
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE E JAEN M.D.
Provider Business Mailing Address
First Line : 6141 SUNSET DR
Second Line : SUITE #403
City : SOUTH MIAMI
State : FL
Zip : 33143-5028
Country : US
Telephone Number : 305-669-5151
Fax Number : 305-669-2151
Provider Business Practice Location Address
First Line : 6619 S DIXIE HWY
Second Line : PMB 272
City : MIAMI
State : FL
Zip : 33143-7919
Country : US
Telephone Number : 305-669-5151
Fax Number : 305-669-2151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 05/28/2014

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Directions to “ JOSE E JAEN M.D.” Practice Location

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