Provider Demographics
NPI:1023087707
Name:LLANES, JESUS M JR (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:LLANES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4960 SW 72ND AV
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5506
Mailing Address - Country:US
Mailing Address - Phone:305-662-5200
Mailing Address - Fax:305-284-7940
Practice Address - Street 1:4960 SW 72ND AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5544
Practice Address - Country:US
Practice Address - Phone:305-662-5200
Practice Address - Fax:305-284-7940
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2020-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL49076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49076OtherFLORIDA MEDICAL LICENCE
FL049965000Medicaid
FL049965000Medicaid
FLD50365Medicare UPIN