Provider Demographics
NPI:1598733552
Name:NIETO, JOE (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:NIETO
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 1:10867 CAMINO CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9303
Mailing Address - Country:US
Mailing Address - Phone:561-827-2170
Mailing Address - Fax:
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2737
Practice Address - Country:US
Practice Address - Phone:800-617-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8382207P00000X
FLME0077039207P00000X
CAG88921207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51914OtherBCBS
TX204612003Medicaid
P00094695OtherRAILROAD MEDICARE
TX204612002Medicaid
FL260869300Medicaid
P00094695OtherRAILROAD MEDICARE
TX204612003Medicaid
FL260869300Medicaid
TX349625YKN5Medicare PIN