Provider Demographics
NPI:1922068717
Name:FIERRO, JOSE MARIA (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MARIA
Last Name:FIERRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:MARIA
Other - Last Name:FIERRO-CUETO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14519 W HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8224
Mailing Address - Country:US
Mailing Address - Phone:623-536-6328
Mailing Address - Fax:
Practice Address - Street 1:14519 W HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8224
Practice Address - Country:US
Practice Address - Phone:623-536-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29818207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ711318Medicaid
H80794Medicare UPIN
AZH80794Medicare UPIN
AZ711318Medicaid