Provider Demographics
NPI:1093748428
Name:PRIETO, JOSE RAMON (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:PRIETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:214 MORRISON RD STE 104
Mailing Address - Street 2:BRANDON
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4849
Mailing Address - Country:US
Mailing Address - Phone:813-681-6474
Mailing Address - Fax:813-654-8473
Practice Address - Street 1:214 MORRISON RD STE 104
Practice Address - Street 2:BRANDON
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4849
Practice Address - Country:US
Practice Address - Phone:813-681-6474
Practice Address - Fax:813-654-8473
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL0051439207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269481600Medicaid
FL37556ZMedicare ID - Type Unspecified
FLG70136Medicare UPIN