MEDICARE: JOSE R. FORADADA, III, MD, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	ARNP3390982	FL
2	363LP0200X	Pediatric Nurse Practitioner	ARNP9263175	FL
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME0056885	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164766002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE R. FORADADA, III, MD, P.A.

Provider Business Mailing Address
First Line	:	4710 N. HABANA AVE.
Second Line	:	SUITE 307
City	:	TAMPA
State	:	FL
Zip	:	33614-7151
Country	:	US
Telephone Number	:	813-874-2000
Fax Number	:	813-874-9303

Provider Business Practice Location Address
First Line	:	4710 N. HABANA AVE.
Second Line	:	SUITE 307
City	:	TAMPA
State	:	FL
Zip	:	33614-7151
Country	:	US
Telephone Number	:	813-874-2000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE RAMON FORADADA III
Credential	:	M.D.
Telephone Number	:	813-874-2000

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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