Provider Demographics
NPI:1548534597
Name:ENRIQUE J HUERTAS JR MD PA
Entity type:Organization
Organization Name:ENRIQUE J HUERTAS JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-649-4117
Mailing Address - Street 1:1831 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3503
Mailing Address - Country:US
Mailing Address - Phone:305-649-4117
Mailing Address - Fax:305-649-4207
Practice Address - Street 1:1831 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3503
Practice Address - Country:US
Practice Address - Phone:305-649-4117
Practice Address - Fax:305-649-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 44902207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049756800Medicaid
04861Medicare PIN
FL049756800Medicaid