Provider Demographics
NPI:1235197799
Name:VALE, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:VALE
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:L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43301-1814
Practice Address - Country:US
Practice Address - Phone:740-383-7950
Practice Address - Fax:740-383-7097
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064214V208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
644856OtherAETNA
OH000000118449OtherANTHEM
1700623OtherUHC
020018140OtherTRAVELERS MEDICARE
OH0897847Medicaid
1700623OtherUHC
F30728Medicare UPIN
OH000000118449OtherANTHEM
OH000000118449OtherANTHEM
311098079OtherTAX ID
F30728Medicare UPIN
OHH125370Medicare PIN