Provider Demographics
NPI:1427590918
Name:THIERRY JACQUEMIN D.O., P.A
Entity Type:Organization
Organization Name:THIERRY JACQUEMIN D.O., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THIERRY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JACQUEMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-667-1511
Mailing Address - Street 1:3850 BIRD RD
Mailing Address - Street 2:SUITE # 501
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1501
Mailing Address - Country:US
Mailing Address - Phone:305-667-1511
Mailing Address - Fax:305-503-8955
Practice Address - Street 1:3850 BIRD RD
Practice Address - Street 2:SUITE # 501
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1501
Practice Address - Country:US
Practice Address - Phone:305-667-1511
Practice Address - Fax:305-503-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBS88STOtherMEDICARE
FL1750407086OtherNPI INDIVIDUAL
FL001536700Medicaid