Provider Demographics
NPI:1093877631
Name:JODESTY, YVES MICHEL ANTOINE (MD)
Entity Type:Individual
Prefix:DR
First Name:YVES
Middle Name:MICHEL ANTOINE
Last Name:JODESTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6101
Mailing Address - Country:US
Mailing Address - Phone:954-728-9200
Mailing Address - Fax:
Practice Address - Street 1:1000 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6137
Practice Address - Country:US
Practice Address - Phone:954-728-9200
Practice Address - Fax:954-728-8660
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253591200Medicaid
FL253591200Medicaid
B87352Medicare UPIN