Provider Demographics
NPI:1326222795
Name:MD MEDICARE CHOICE
Entity Type:Organization
Organization Name:MD MEDICARE CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ESPARRA
Authorized Official - Last Name:CANSOBRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1813-901-9208
Mailing Address - Street 1:5501 W WATERS AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1229
Mailing Address - Country:US
Mailing Address - Phone:813-901-9208
Mailing Address - Fax:813-901-9209
Practice Address - Street 1:5501 W WATERS AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1229
Practice Address - Country:US
Practice Address - Phone:813-901-9208
Practice Address - Fax:813-901-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH5729302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization