Provider Demographics
NPI: | 1821106527 |
---|---|
Name: | PAEZ, RENE A (MD) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | RENE |
Middle Name: | A |
Last Name: | PAEZ |
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: | 7300 SW 62ND PL FL 3 |
Mailing Address - Street 2: | |
Mailing Address - City: | SOUTH MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33143-4800 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-665-1133 |
Mailing Address - Fax: | 305-666-0258 |
Practice Address - Street 1: | 7300 SW 62ND PL |
Practice Address - Street 2: | 3 FL |
Practice Address - City: | SOUTH MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33143-4806 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-665-1133 |
Practice Address - Fax: | 305-666-0258 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-25 |
Last Update Date: | 2020-03-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME78759 | 174400000X, 207VX0000X, 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | |
No | 174400000X | Other Service Providers | Specialist | |
No | 207VX0000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | H34605 | Medicare UPIN |