Provider Demographics
NPI:1508868779
Name:POZO, JOSE JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JORGE
Last Name:POZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME906072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270417000Medicaid
FLI11878Medicare UPIN
FL270417000Medicaid