Provider Demographics
NPI:1023109477
Name:CABRERA, JOSE I (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:I
Last Name:CABRERA
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 1:3067 TAMIAMI TRL
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6619
Mailing Address - Country:US
Mailing Address - Phone:941-258-3515
Mailing Address - Fax:941-258-3519
Practice Address - Street 1:3067 TAMIAMI TRL
Practice Address - Street 2:UNIT 2
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6619
Practice Address - Country:US
Practice Address - Phone:941-258-3515
Practice Address - Fax:941-258-3519
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57563207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000305000Medicaid
FL278507205Medicaid
FL11681VMedicare PIN
FL000305000Medicaid
FLC28739Medicare UPIN