Provider Demographics
NPI:1568656452
Name:ROYO, JOSE M (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:ROYO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11354 SW 184TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6570
Mailing Address - Country:US
Mailing Address - Phone:305-971-8151
Mailing Address - Fax:305-971-8151
Practice Address - Street 1:11354 SW 184TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6570
Practice Address - Country:US
Practice Address - Phone:305-971-8151
Practice Address - Fax:305-971-8151
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100892363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical