Provider Demographics
NPI:1043272115
Name:DEOLAZABAL, JOSE ANTONIO (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:DEOLAZABAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:116 POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2830
Mailing Address - Country:US
Mailing Address - Phone:561-622-3375
Mailing Address - Fax:
Practice Address - Street 1:3400 BURNS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4325
Practice Address - Country:US
Practice Address - Phone:561-694-1101
Practice Address - Fax:561-694-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8634207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI35263Medicare UPIN
FLU5114Medicare ID - Type Unspecified