Provider Demographics
NPI:1093790313
Name:PAEZ, HENRY E (M D)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:E
Last Name:PAEZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 DAY AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5110
Mailing Address - Country:US
Mailing Address - Phone:305-447-8777
Mailing Address - Fax:305-447-8126
Practice Address - Street 1:1898 SW 27TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2445
Practice Address - Country:US
Practice Address - Phone:305-447-8777
Practice Address - Fax:305-447-8126
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13041OtherBCBS
FL264312000Medicaid
P00414262OtherRR MCR
FL264312000Medicaid
FL13041 YMedicare ID - Type Unspecified
FL13041OtherBCBS
P00414262OtherRR MCR