Provider Demographics
NPI:1336128891
Name:VALLADARES, JOSE H (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:H
Last Name:VALLADARES
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:PO BOX 450708
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33245-0708
Mailing Address - Country:US
Mailing Address - Phone:305-541-9300
Mailing Address - Fax:305-541-4644
Practice Address - Street 1:2660 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1415
Practice Address - Country:US
Practice Address - Phone:305-541-9300
Practice Address - Fax:305-541-4644
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME022220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055372700Medicaid
FL92161ZOtherMEDICARE PTAN
FLD59963Medicare UPIN