Provider Demographics
NPI:1518061639
Name:GEDEON, JACQUILOT (RRT)
Entity Type:Individual
Prefix:
First Name:JACQUILOT
Middle Name:
Last Name:GEDEON
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 NE 164TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3538
Mailing Address - Country:US
Mailing Address - Phone:305-944-5469
Mailing Address - Fax:
Practice Address - Street 1:570 NE 164TTH ST
Practice Address - Street 2:
Practice Address - City:NORT MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3538
Practice Address - Country:US
Practice Address - Phone:305-944-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT6990227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8878277Medicaid