Provider Demographics
NPI:1528004413
Name:ARMONIO, JOSE G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:ARMONIO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4798 WOODVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575
Mailing Address - Country:US
Mailing Address - Phone:843-497-1441
Mailing Address - Fax:843-497-3003
Practice Address - Street 1:1301 48TH AVENUE NORTH
Practice Address - Street 2:SUITE B SOUTHEAST MEDICAL ASSOCIATES LLC
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-497-1441
Practice Address - Fax:843-497-3003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC18682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT26503Medicaid
SC7149Medicare ID - Type Unspecified
SCT26503Medicaid