Provider Demographics
NPI:1386674794
Name:MANDRY, JOSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:MANDRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1510 CITRUS MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4547
Mailing Address - Country:US
Mailing Address - Phone:407-480-4830
Mailing Address - Fax:407-480-4834
Practice Address - Street 1:1510 CITRUS MEDICAL CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4547
Practice Address - Country:US
Practice Address - Phone:407-480-4830
Practice Address - Fax:407-480-4834
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0062303207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE88152Medicare UPIN
FL15245ZMedicare ID - Type Unspecified