Provider Demographics
NPI:1003861469
Name:SELEM, JOSE S (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:S
Last Name:SELEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1416 CASTILE AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-720-8668
Mailing Address - Fax:305-444-0223
Practice Address - Street 1:814 PONCE DE LEON BLVD
Practice Address - Street 2:STE 510
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-444-0221
Practice Address - Fax:305-444-0223
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 43828207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068561500Medicaid
FL96544BMedicare ID - Type Unspecified
FL068561500Medicaid