1194717470 NPI number — MR. MIGUEL M LIMERES JR. MD

Table of content: MR. MIGUEL M LIMERES JR. MD (NPI 1194717470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194717470 NPI number — MR. MIGUEL M LIMERES JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIMERES
Provider First Name:
MIGUEL
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194717470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 ZEAGLER DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
PALATKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32177-6856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-326-0223
Provider Business Mailing Address Fax Number:
386-326-0664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 ZEAGLER DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PALATKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32177-6856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-326-0223
Provider Business Practice Location Address Fax Number:
386-326-0664
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME76533 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10714178 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 255727400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44688 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110231697 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 255727400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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