Provider Demographics
NPI:1639124381
Name:JOSE SELEM, M.D., P.A.
Entity Type:Organization
Organization Name:JOSE SELEM, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SELEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-720-8668
Mailing Address - Street 1:1416 CASTILE AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-720-8668
Mailing Address - Fax:305-444-0223
Practice Address - Street 1:814 PONCE DE LEON BLVD
Practice Address - Street 2:STE 510
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-444-0221
Practice Address - Fax:305-444-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 43829207L00000X
207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068561500Medicaid