Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME84372 | FL |
NPI | 1013978816 |
---|---|
Provider Name | Jesus B Menendez |
First Address | Miami, FL 33135-3005 |
Second Address | Miami, FL 33135-3005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 15/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
262153300 | (05) | FL |
H28358 | (02) | FL |