Provider Demographics
NPI:1932337763
Name:VENTURA, JOSE A (MD, FHM, FAAFP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:VENTURA
Suffix:
Gender:M
Credentials:MD, FHM, FAAFP
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:VENTURA LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, FHM, FAAFP
Mailing Address - Street 1:47 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-5524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2652
Practice Address - Country:US
Practice Address - Phone:207-373-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19207207Q00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0000Medicaid