MEDICARE: JOSEPH A IGNACIO D.O.

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	OS014320	PA
2	207Q00000X	Family Medicine Physician	OS10614	FL

General Provider Information

NPI Number	:	1700062494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH A IGNACIO D.O.

Provider Business Mailing Address
First Line	:	806 S DOUGLAS RD
Second Line	:	SUITE 820
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3157
Country	:	US
Telephone Number	:	305-447-4150
Fax Number	:	305-448-8186

Provider Business Practice Location Address
First Line	:	806 S DOUGLAS RD
Second Line	:	SUITE 820
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3157
Country	:	US
Telephone Number	:	305-447-4150
Fax Number	:	305-448-8186

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

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	09/19/2013

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