Healthcare Provider Details

I. General information

NPI: 1508868779
Provider Name (Legal Business Name): JOSE JORGE POZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 NW PEACOCK BLVD SUITE 101
PORT ST LUCIE FL
34986-2274
US

IV. Provider business mailing address

240 NW PEACOCK BLVD SUITE 101
PORT ST LUCIE FL
34986-2274
US

V. Phone/Fax

Practice location:
  • Phone: 772-878-5057
  • Fax: 772-878-5703
Mailing address:
  • Phone: 772-878-5057
  • Fax: 772-878-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME90607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: