Provider Demographics
NPI:1376723080
Name:NERY, JOSE ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ROBERTO
Last Name:NERY
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 1:7110 SW 109TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3968
Mailing Address - Country:US
Mailing Address - Phone:305-661-0171
Mailing Address - Fax:305-847-8371
Practice Address - Street 1:7701 SW 98TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2634
Practice Address - Country:US
Practice Address - Phone:305-661-0171
Practice Address - Fax:305-847-8371
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66867Medicare UPIN