Provider Demographics
NPI:1053529677
Name:JOSE MANUEL SANCHEZ MD PA
Entity type:Organization
Organization Name:JOSE MANUEL SANCHEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-801-4160
Mailing Address - Street 1:PO BOX 565811
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-5811
Mailing Address - Country:US
Mailing Address - Phone:305-964-7392
Mailing Address - Fax:305-726-0016
Practice Address - Street 1:475 BILTMORE WAY
Practice Address - Street 2:204
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5736
Practice Address - Country:US
Practice Address - Phone:305-964-7392
Practice Address - Fax:305-726-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93486207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001257300Medicaid
FL001257300Medicaid