Provider Demographics
NPI:1639253859
Name:CALDERON, JOSE L (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:CALDERON
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 1:28960 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2403
Mailing Address - Country:US
Mailing Address - Phone:727-785-7686
Mailing Address - Fax:727-785-9669
Practice Address - Street 1:28960 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 109
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2403
Practice Address - Country:US
Practice Address - Phone:727-785-7686
Practice Address - Fax:727-785-9669
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96046207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00867672OtherRAILROAD MEDICARE PROVIDER NUMBER
FL276207200Medicaid
FLAD027ZMedicare PIN
FLP00867672OtherRAILROAD MEDICARE PROVIDER NUMBER
FLI74205Medicare UPIN