Provider Demographics
NPI:1629092283
Name:MOLE, JOSE R (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:MOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6054
Mailing Address - Country:US
Mailing Address - Phone:813-930-0930
Mailing Address - Fax:813-930-0950
Practice Address - Street 1:2931 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6054
Practice Address - Country:US
Practice Address - Phone:813-930-0930
Practice Address - Fax:813-930-0950
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0092632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL342066019OtherEIN
FL29567XMedicare PIN
FL342066019OtherEIN