MEDICARE: DR. JOSE M MANDRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	0062303	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386674794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE M MANDRY M.D.

Provider Business Mailing Address
First Line	:	1510 CITRUS MEDICAL CT
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4547
Country	:	US
Telephone Number	:	407-480-4830
Fax Number	:	407-480-4834

Provider Business Practice Location Address
First Line	:	1510 CITRUS MEDICAL CT
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4547
Country	:	US
Telephone Number	:	407-480-4830
Fax Number	:	407-480-4834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	12/05/2016

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