Healthcare Provider Details

I. General information

NPI: 1376573782
Provider Name (Legal Business Name): JOSE A PRIETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 6TH AVE S STE 340
ST PETERSBURG FL
33701-4662
US

IV. Provider business mailing address

625 6TH AVE S STE 340
ST PETERSBURG FL
33701-4662
US

V. Phone/Fax

Practice location:
  • Phone: 727-553-7903
  • Fax: 727-553-7905
Mailing address:
  • Phone: 727-553-7903
  • Fax: 727-553-7905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME 70330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: