Healthcare Provider Details

I. General information

NPI: 1851382881
Provider Name (Legal Business Name): JOSE E PIOVANETTI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/07/2023
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7824 LAKE UNDERHILL RD STE E
ORLANDO FL
32822-8201
US

IV. Provider business mailing address

5104 KINGWELL CIR
OVIEDO FL
32765-9092
US

V. Phone/Fax

Practice location:
  • Phone: 407-282-2001
  • Fax: 407-286-6064
Mailing address:
  • Phone: 787-615-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberACN838
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN838
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12736
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberACN838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: