MEDICARE: ENRIQUE J HUERTAS JR MD PA

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	207RC0000X	Cardiovascular Disease Physician	ME 44902	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1548534597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRIQUE J HUERTAS JR MD PA

Provider Business Mailing Address
First Line	:	1831 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3503
Country	:	US
Telephone Number	:	305-649-4117
Fax Number	:	305-649-4207

Provider Business Practice Location Address
First Line	:	1831 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3503
Country	:	US
Telephone Number	:	305-649-4117
Fax Number	:	305-649-4207

Authorized Official
Title or Position	:	OWNER
Name	:	ENRIQUE HUERTAS
Credential	:	MD
Telephone Number	:	305-649-4117

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	03/07/2012

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