Provider Demographics
NPI:1548406838
Name:JOSE E. JAEN MD PA
Entity Type:Organization
Organization Name:JOSE E. JAEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-823-1555
Mailing Address - Street 1:7100 W 20TH AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1897
Mailing Address - Country:US
Mailing Address - Phone:305-823-1555
Mailing Address - Fax:305-823-4660
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:STE 302
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-823-1555
Practice Address - Fax:305-823-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96800VMedicare PIN
FLD28022Medicare UPIN