Provider Demographics
NPI:1104845460
Name:ORELLANA, JOSE R (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:ORELLANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1600
Mailing Address - Fax:239-424-1640
Practice Address - Street 1:1682 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1756
Practice Address - Country:US
Practice Address - Phone:239-424-1600
Practice Address - Fax:239-424-1640
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035834207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT035834OtherCONNECTICARE
CT110201457OtherRAILROAD MEDICARE
CT010035834CT02OtherANTHEN BC/BS
FL104923300Medicaid
CTP490553OtherOXFORD
CT00135834101OtherBLUE CARE FAMILY PLAN
CT061571622OtherCIGNA
CT2286093OtherAETNA
CT001358341Medicaid
CT061571622OtherUNITED HEALTHCARE
CTOV6505OtherHEALTHNET
CT001358341Medicaid