Provider Demographics
NPI:1649488297
Name:PIERRE, JEAN MARIO (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIO
Last Name:PIERRE
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 1:5050 BISCAYNE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3203
Mailing Address - Country:US
Mailing Address - Phone:786-281-6534
Mailing Address - Fax:
Practice Address - Street 1:5050 BISCAYNE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3203
Practice Address - Country:US
Practice Address - Phone:786-281-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81585208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME81585OtherPROFESSIONAL LICENSE
FLME81585OtherPROFESSIONAL LICENSE