Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME77345 | FL |
N | 2080P0201X | Pediatric Allergist | 035659 | CT |
N | 2080P0201X | Pediatric Allergist | 35659 | CT |
NPI | 1699758813 |
---|---|
Provider Name | Jose G Calderon |
First Address | Miami, FL 33155-3009 |
Second Address | Miami, FL 33155-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 18/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001356593 | (05) | CT |
008381300 | (05) | FL |
G71690 | (02) |