MEDICARE: JOSE A PORRAS PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	PA 9106388	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

General Provider Information

NPI Number	:	1548533433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE A PORRAS PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	3255 FOREST HILL BLVD STE 103
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5854
Country	:	US
Telephone Number	:	561-964-4577
Fax Number	:	561-964-7772

Provider Business Practice Location Address
First Line	:	3255 FOREST HILL BLVD STE 103
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5854
Country	:	US
Telephone Number	:	561-964-4577
Fax Number	:	561-964-7772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	08/08/2022

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