Healthcare Provider Details

I. General information

NPI: 1841427861
Provider Name (Legal Business Name): JOSE L BORRERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 JASMINE RD
ALTAMONTE SPRINGS FL
32701-4807
US

IV. Provider business mailing address

630 JASMINE RD
ALTAMONTE SPRINGS FL
32701-4807
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-6632
  • Fax: 407-862-5454
Mailing address:
  • Phone: 407-834-6632
  • Fax: 407-862-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberME29468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: