Provider Demographics
NPI:1598876450
Name:REMO, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:REMO
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 1:101 PROGRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2359
Mailing Address - Country:US
Mailing Address - Phone:573-468-3555
Mailing Address - Fax:
Practice Address - Street 1:101 PROGRESS PKWY
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2359
Practice Address - Country:US
Practice Address - Phone:573-468-3555
Practice Address - Fax:573-468-3554
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5N92207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203200506Medicaid
MO1598876450Medicaid
MOP01135367OtherRAILROAD MEDICARE
P00435679OtherRAILROAD MEDICARE
MO152810054Medicare PIN
MO203200506Medicaid
326072943Medicare Oscar/Certification
326072943Medicare PIN