Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | ME122607 | FL |
N | 207RP1001X | Pulmonary Disease | M-1886 | GU |
NPI | 1063654309 |
---|---|
Provider Name | Jose Jersey Gonzalez Huertas |
First Address | Margate, FL 33063-5727 |
Second Address | Margate, FL 33063-5727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M-1886 | GUAM BOARD MEDICAL EXAMINERS (01) | GU |