Provider Demographics
NPI:1558625863
Name:MANUEL, JOSE AZANZA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:AZANZA
Last Name:MANUEL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:5831 BEE RIDGE RD STE 210
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5094
Practice Address - Country:US
Practice Address - Phone:941-379-8481
Practice Address - Fax:941-379-3781
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2021-02-10
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Provider Licenses
StateLicense IDTaxonomies
MI4301100603207Q00000X
WAMD60840812207Q00000X
MO2015021634207Q00000X
FLME146621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2108219Medicaid
MO1558625863Medicaid