Provider Demographics
NPI:1679804769
Name:JOSE R AZARET, MD PA
Entity type:Organization
Organization Name:JOSE R AZARET, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AZARET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-551-6260
Mailing Address - Street 1:11880 BIRD RD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-551-6260
Mailing Address - Fax:305-220-1258
Practice Address - Street 1:11880 BIRD RD
Practice Address - Street 2:SUITE 319
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3584
Practice Address - Country:US
Practice Address - Phone:305-551-6260
Practice Address - Fax:305-220-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27866208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274208000Medicaid
FL274208000Medicaid