Healthcare Provider Details

I. General information

NPI: 1013972967
Provider Name (Legal Business Name): JOSE IRIZARRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3609
US

IV. Provider business mailing address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3609
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-5000
  • Fax: 659-659-6039
Mailing address:
  • Phone: 954-659-5000
  • Fax: 659-659-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME0071728
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35065626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: