Healthcare Provider Details

I. General information

NPI: 1568458388
Provider Name (Legal Business Name): JOSE ALFONSO PIZARRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE ALFONSO PIZARRO DIAZ

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 CARTMEL LN
WINDERMERE FL
34786-5423
US

IV. Provider business mailing address

11995 SINGLETREE LN SUITE 500
EDEN PRAIRIE MN
55344-5347
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax: 952-942-3361
Mailing address:
  • Phone: 952-595-1100
  • Fax: 952-942-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME81849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: