Provider Demographics
NPI:1013178169
Name:NODARSE, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:NODARSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 S SEACREST BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7944
Mailing Address - Country:US
Mailing Address - Phone:561-413-2850
Mailing Address - Fax:561-651-9059
Practice Address - Street 1:2828 S SEACREST BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7944
Practice Address - Country:US
Practice Address - Phone:561-413-2850
Practice Address - Fax:561-651-9059
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-21
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96240207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000898800Medicaid
FLCF910ZMedicare PIN