Provider Demographics
NPI:1972528545
Name:DE LA HOZ, JAIRO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:ANTONIO
Last Name:DE LA HOZ
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:PO BOX 17723
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246
Mailing Address - Country:US
Mailing Address - Phone:904-800-2332
Mailing Address - Fax:904-634-7892
Practice Address - Street 1:5233 RICKER ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:904-800-2332
Practice Address - Fax:904-634-7892
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME70797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251739600Medicaid
FLG36596Medicare UPIN
FL31309XMedicare PIN