Provider Demographics
NPI:1689661928
Name:PICAZO, JOSE S (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:S
Last Name:PICAZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 CHRISTIANA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1656
Mailing Address - Country:US
Mailing Address - Phone:302-738-6535
Mailing Address - Fax:302-738-6517
Practice Address - Street 1:600 CHRISTIANA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1656
Practice Address - Country:US
Practice Address - Phone:302-738-6535
Practice Address - Fax:302-738-6517
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DE0005063207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000807001Medicaid
DE0000807001Medicaid
G57338Medicare UPIN