Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | ME0060467 | FL |
N | 2086S0122X | Plastic and Reconstructive Surgery | ME0060467 | FL |
NPI | 1609941244 |
---|---|
Provider Name | Mr. Jesse Orlando Basadre |
First Address | Miami, FL 33145-2074 |
Second Address | Miami, FL 33145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 07/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E96745 | (02) |