Healthcare Provider Details

I. General information

NPI: 1952374225
Provider Name (Legal Business Name): JOSE RAMON IRIZARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901
US

IV. Provider business mailing address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0406
  • Fax: 407-975-0407
Mailing address:
  • Phone: 407-975-0406
  • Fax: 407-975-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10561
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME106787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: