Provider Demographics
NPI:1538466917
Name:JOSE A. BERRIOS, MD PA
Entity Type:Organization
Organization Name:JOSE A. BERRIOS, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-684-0949
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33595-0105
Mailing Address - Country:US
Mailing Address - Phone:813-684-0949
Mailing Address - Fax:813-654-7105
Practice Address - Street 1:320 OAKFIELD DR
Practice Address - Street 2:SUITE D
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5723
Practice Address - Country:US
Practice Address - Phone:813-684-0949
Practice Address - Fax:813-654-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD10178Medicare UPIN
FL30705Medicare PIN