Provider Demographics
NPI:1578570685
Name:FLOREZ, JOSE C (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:C
Last Name:FLOREZ
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8722
Mailing Address - Fax:617-724-8534
Practice Address - Street 1:50 STANIFORD STREET
Practice Address - Street 2:DIABETES UNIT 3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-8722
Practice Address - Fax:617-724-8534
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA205354207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0142760Medicaid
MA454678OtherTUFTS HEALTH PLAN
MAJ24049OtherBCBS MA
MAJ24049OtherBCBS MA
MAA32797Medicare ID - Type Unspecified