Provider Demographics
NPI:1558380808
Name:CONDE, JOSE LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:CONDE
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 1:13590 JOG RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3807
Mailing Address - Country:US
Mailing Address - Phone:561-496-2200
Mailing Address - Fax:561-495-4699
Practice Address - Street 1:13590 JOG RD
Practice Address - Street 2:SUITE 4
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3807
Practice Address - Country:US
Practice Address - Phone:561-496-2200
Practice Address - Fax:561-495-4699
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93979207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine