Provider Demographics
NPI:1053756627
Name:JOSE DAVID SUAREZ MD PA
Entity type:Organization
Organization Name:JOSE DAVID SUAREZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-1113
Mailing Address - Street 1:6161 SUNSET DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5045
Mailing Address - Country:US
Mailing Address - Phone:305-663-1113
Mailing Address - Fax:305-663-1119
Practice Address - Street 1:6161 SUNSET DR
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5045
Practice Address - Country:US
Practice Address - Phone:305-663-1113
Practice Address - Fax:305-663-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379544600Medicaid
FLG38264Medicare UPIN
FL28229DMedicare PIN