Provider Demographics
NPI:1679962740
Name:JOSE S BASAGOITIA,M.D
Entity type:Organization
Organization Name:JOSE S BASAGOITIA,M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:BASAGOITIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-854-0445
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE# 705
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-854-0445
Mailing Address - Fax:305-854-5099
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE# 705
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-854-0445
Practice Address - Fax:305-854-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty