Provider Demographics
NPI:1457862799
Name:PURON BARRERAS, JOSE RAMON (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:PURON BARRERAS
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 1:513 NW 5TH AVE APT 1026
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3379
Mailing Address - Country:US
Mailing Address - Phone:786-716-5057
Mailing Address - Fax:
Practice Address - Street 1:1521 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-3807
Practice Address - Country:US
Practice Address - Phone:786-594-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
PR16017-I390200000X
FLACN1464208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program