Healthcare Provider Details

I. General information

NPI: 1386037224
Provider Name (Legal Business Name): JOSE CARDOSO D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 11/02/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 GOODLETTE-FRANK RD N STE 230
NAPLES FL
34102-5615
US

IV. Provider business mailing address

671 GOODLETTE-FRANK RD N STE 230
NAPLES FL
34102-5615
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-9501
  • Fax: 239-692-8486
Mailing address:
  • Phone: 239-304-9501
  • Fax: 855-707-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS15215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: