Provider Demographics
NPI:1598850521
Name:PAGAN, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:PAGAN
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 1:8145 CEREBELLUM WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1788
Mailing Address - Country:US
Mailing Address - Phone:727-781-3448
Mailing Address - Fax:866-777-2195
Practice Address - Street 1:2595 TAMPA RD STE G
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3130
Practice Address - Country:US
Practice Address - Phone:727-781-3448
Practice Address - Fax:866-777-2195
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040616207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260609255OtherGROUP TAX ID
FL001553500OtherGROUP MEDICAID
FL067804000Medicaid
FL1386823243OtherGROUP NPI
FLBC538GOtherGROUP MEDICARE NEW PORT RICHEY
FLBC538AOtherGROUP MEDICARE PALM HARBOR
FL260609255OtherGROUP TAX ID
FL1386823243OtherGROUP NPI
FL62439XMedicare PIN