Provider Demographics
NPI:1841308475
Name:FORADADA, JOSE R III (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:FORADADA
Suffix:III
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 1:4710 N HABANA AVENUE
Mailing Address - Street 2:STE 307
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614
Mailing Address - Country:US
Mailing Address - Phone:813-874-2000
Mailing Address - Fax:813-875-9303
Practice Address - Street 1:4710 N HABANA AVENUE
Practice Address - Street 2:STE 307
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-874-2000
Practice Address - Fax:813-875-9303
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME568852084N0400X
FLME00568852084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273113400Medicaid
FL06249000Medicaid
F03028Medicare UPIN