Basic Information
| Provider Information | |||||||||
| NPI: | 1457862799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURON BARRERAS | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | RAMON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 513 NW 5TH AVE APT 1026 | ||||||||
| Address2: | |||||||||
| City: | FLORIDA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330343379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7867165057 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1521 NW 54TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331423807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865940000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2017 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 390200000X | 16017-I | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | ACN1464 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.