Healthcare Provider Details

I. General information

NPI: 1487846499
Provider Name (Legal Business Name): JOSE ANTONIO SANCHEZ MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 W DE LEON ST SUITE 203
TAMPA FL
33609-4130
US

IV. Provider business mailing address

2835 W DE LEON ST SUITE 203
TAMPA FL
33609-4130
US

V. Phone/Fax

Practice location:
  • Phone: 813-251-0194
  • Fax: 813-254-0279
Mailing address:
  • Phone: 813-251-0194
  • Fax: 813-254-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME23223
License Number StateFL

VIII. Authorized Official

Name: DR. JOSE ANTONIO SANCHEZ
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 813-251-0194