MEDICARE: HENRY E PAEZ 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
1	207Q00000X	Family Medicine Physician	ME81996	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13041	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P00414262	OTHER		RR MCR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093790313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY E PAEZ M D

Provider Business Mailing Address
First Line	:	3125 DAY AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-5110
Country	:	US
Telephone Number	:	305-447-8777
Fax Number	:	305-447-8126

Provider Business Practice Location Address
First Line	:	1898 SW 27TH AVE
Second Line	:	SUITE 1
City	:	MIAMI
State	:	FL
Zip	:	33145-2445
Country	:	US
Telephone Number	:	305-447-8777
Fax Number	:	305-447-8126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	12/17/2007

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Directions to “ HENRY E PAEZ M D” Practice Location

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