Provider Demographics
NPI:1801820212
Name:MORENO, JOSE N (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:N
Last Name:MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7800 S.W. 87TH AVENUE
Mailing Address - Street 2:SUITE C-340
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-595-0109
Mailing Address - Fax:305-595-7092
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:BOX 016960 M851
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-4664
Practice Address - Fax:305-243-8470
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME51429207K00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0486876-00Medicaid
07441Medicare ID - Type Unspecified
FL0486876-00Medicaid