Provider Demographics
NPI:1346439114
Name:DR JOSE J POZO PA
Entity Type:Organization
Organization Name:DR JOSE J POZO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:POZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-878-5057
Mailing Address - Street 1:240 NW PEACOCK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2274
Mailing Address - Country:US
Mailing Address - Phone:772-878-5057
Mailing Address - Fax:772-878-5703
Practice Address - Street 1:240 NW PEACOCK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2274
Practice Address - Country:US
Practice Address - Phone:772-878-5057
Practice Address - Fax:772-878-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME906072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6018Medicare PIN