Provider Demographics
NPI:1811029143
Name:MEDINA, JOSE F (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:F
Last Name:MEDINA
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:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0848
Mailing Address - Country:US
Mailing Address - Phone:787-859-4503
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE BOU
Practice Address - Street 2:BARRIO PUEBLO
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2011
Practice Address - Country:US
Practice Address - Phone:787-859-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4983208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR300043Medicare ID - Type Unspecified