Healthcare Provider Details

I. General information

NPI: 1861433559
Provider Name (Legal Business Name): JOSE A FERREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S HABANA AVE SUITE 340
TAMPA FL
33609-4181
US

IV. Provider business mailing address

508 S HABANA AVE SUITE 340
TAMPA FL
33609-4181
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-7367
  • Fax: 813-875-9722
Mailing address:
  • Phone: 813-873-7367
  • Fax: 813-875-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME65761
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME65761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: