Provider Demographics
NPI:1578549499
Name:AZOCAR, JOSE D (MD SCD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:D
Last Name:AZOCAR
Suffix:
Gender:M
Credentials:MD SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-0789
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:1985 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1095
Practice Address - Country:US
Practice Address - Phone:413-733-9955
Practice Address - Fax:413-733-1199
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3138259Medicaid
MAJ14363Medicare PIN
MA3138259Medicaid
P00121949Medicare PIN