Provider Demographics
NPI:1396249637
Name:SEASIDE PEDIATRICS OF KEY WEST
Entity type:Organization
Organization Name:SEASIDE PEDIATRICS OF KEY WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEXIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-295-7337
Mailing Address - Street 1:1201 WHITE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3328
Mailing Address - Country:US
Mailing Address - Phone:305-295-7337
Mailing Address - Fax:305-295-0597
Practice Address - Street 1:1201 WHITE ST STE 103
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3328
Practice Address - Country:US
Practice Address - Phone:305-295-7337
Practice Address - Fax:305-295-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125918208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty