Provider Demographics
NPI:1912960154
Name:NEGRETTE, JESUS S (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:S
Last Name:NEGRETTE
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 1:3601 FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3795
Mailing Address - Country:US
Mailing Address - Phone:305-567-6611
Mailing Address - Fax:786-476-2819
Practice Address - Street 1:3601 FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3795
Practice Address - Country:US
Practice Address - Phone:305-567-6611
Practice Address - Fax:786-476-2819
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49543174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061422000Medicaid
FLME49543OtherMEDICAL LICENSE
FL10408OtherBLUE CROSS BLUE SHIELD #
FLME49543OtherMEDICAL LICENSE
FL10408WMedicare PIN