Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | ME63851 | FL |
NPI | 1013959246 |
---|---|
Provider Name | Jose Perez-Tirse |
First Address | Miami, FL 33283-1706 |
Second Address | Miami, FL 33175-3582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 10/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23124X | MEDICARE PTAN (01) | FL |
378108900 | (05) | FL |
Y64689 | (02) | FL |