Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME89082 | FL |
NPI | 1003896507 |
---|---|
Provider Name | Jane Evelyn Matos-Fraebel |
First Address | Plantation, FL 33324-2754 |
Second Address | Plantation, FL 33324-2754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 24/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263355 | AVMED (01) | FL |
271407800 | (05) | FL |
37799 | BCBS OF FL (01) | FL |
I11397 | (02) | FL |