Provider Demographics
NPI:1326282013
Name:DE APODACA, JOSE PEREZ GONZALEZ (MD/PHD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:PEREZ GONZALEZ
Last Name:DE APODACA
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:PEREZ GONZALEZ DE APODACA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD/PHD
Mailing Address - Street 1:7522N HIMES AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3205
Mailing Address - Country:ES
Mailing Address - Phone:813-931-0500
Mailing Address - Fax:813-935-4055
Practice Address - Street 1:206 BUCKINGHAM PL STE 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4910
Practice Address - Country:US
Practice Address - Phone:813-653-2020
Practice Address - Fax:813-653-2205
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436842207W00000X
FLME121607207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology