Provider Demographics
NPI:1134210271
Name:GAMEZ, JOSE EDGARDO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:EDGARDO
Last Name:GAMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 WEST 20TH AVENUE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-820-3381
Mailing Address - Fax:305-820-0937
Practice Address - Street 1:7100 WEST 20TH AVENUE
Practice Address - Street 2:SUITE 503
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-820-3381
Practice Address - Fax:305-820-0937
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00571272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057209800Medicaid
FLE67918Medicare UPIN
FL057209800Medicaid