Provider Demographics
NPI:1346231008
Name:REGO, JAIME (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:REGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3410 W 84TH ST
Mailing Address - Street 2:BLDG F SUITE 110
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:305-558-3571
Mailing Address - Fax:305-558-3682
Practice Address - Street 1:3410 W 84TH ST
Practice Address - Street 2:BLDG F SUITE 110
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:305-558-3571
Practice Address - Fax:305-558-3682
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0077162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46204ZMedicare PIN
G91115Medicare UPIN
FL46204YMedicare PIN