1275881229 NPI number — JEAN PAUL FONT MD PA

Table of content: (NPI 1275881229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275881229 NPI number — JEAN PAUL FONT MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEAN PAUL FONT MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1275881229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13055 SW 42ND ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33175-3406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-559-7996
Provider Business Mailing Address Fax Number:
305-559-8316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11760 SW 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 416
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33175-3582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-485-7881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FONT
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-485-7881

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME106115 , 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: 003017100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com