Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME68133 | FL |
N | 2080N0001X | Neonatal-Perinatal Doctor | ME68133 | FL |
Y | 2080P0202X | Pediatric Cardiologist | ME68133 | FL |
NPI | 1104017888 |
---|---|
Provider Name | Dr. Jack William Bandel |
First Address | Miami, FL 33180-1147 |
Second Address | Miami, FL 33180-1147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104831200 | (05) | FL |