MEDICARE: DR. JOSE ANTONIO PAGAN 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	207V00000X	Obstetrics & Gynecology Physician	ME0040616	FL
2	207VG0400X	Gynecology Physician	ME0040616	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	BC538G	OTHER	FL	GROUP MEDICARE NEW PORT RICHEY
6	BC538A	OTHER	FL	GROUP MEDICARE PALM HARBOR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260609255	OTHER	FL	GROUP TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1386823243	OTHER	FL	GROUP NPI

General Provider Information

NPI Number	:	1598850521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ANTONIO PAGAN M.D.

Provider Business Mailing Address
First Line	:	8145 CEREBELLUM WAY
Second Line	:	SUITE 101
City	:	TRINITY
State	:	FL
Zip	:	34655-1788
Country	:	US
Telephone Number	:	727-781-3448
Fax Number	:	866-777-2195

Provider Business Practice Location Address
First Line	:	2595 TAMPA RD STE G
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3130
Country	:	US
Telephone Number	:	727-781-3448
Fax Number	:	866-777-2195

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/10/2017

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