Provider Demographics
NPI:1497779706
Name:DE OLAZABAL, JOSE ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ROBERTO
Last Name:DE OLAZABAL
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 1:3400 BURNS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4325
Mailing Address - Country:US
Mailing Address - Phone:561-694-1101
Mailing Address - Fax:561-694-1102
Practice Address - Street 1:3400 BURNS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4325
Practice Address - Country:US
Practice Address - Phone:561-694-1101
Practice Address - Fax:561-694-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42106207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE34767Medicare UPIN
61285Medicare ID - Type Unspecified