Provider Demographics
NPI:1386037224
Name:CARDOSO, JOSE (DO)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CARDOSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 GOODLETTE-FRANK RD N STE 230
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5615
Mailing Address - Country:US
Mailing Address - Phone:239-304-9501
Mailing Address - Fax:855-707-1410
Practice Address - Street 1:671 GOODLETTE-FRANK RD N STE 230
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5615
Practice Address - Country:US
Practice Address - Phone:239-304-9501
Practice Address - Fax:239-692-8486
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15215207R00000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100063100Medicaid