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NPI Code Detail

MEDICARE: ALAN JOSE MD

MEDICARE: ALAN JOSE MD
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
1207R00000XInternal Medicine Physician2010014288MO

General Provider Information

NPI Number : 1902110240
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALAN JOSE MD
Provider Business Mailing Address
First Line : 6420 CLAYTON ROAD
Second Line : SSM ST MARYS HEALTH CENTER/ DEPT OF INTERNAL MEDICINE
City : ST LOUIS
State : MO
Zip : 63117-1872
Country : US
Telephone Number : 314-768-8778
Fax Number : 314-768-7101
Provider Business Practice Location Address
First Line : 6420 CLAYTON ROAD
Second Line : SSM ST MARYS HEALTH CENTER/ DEPT OF INTERNAL MEDICINE
City : ST LOUIS
State : MO
Zip : 63117-1872
Country : US
Telephone Number : 314-768-8778
Fax Number : 314-768-7101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2010
Last Update Date : 07/28/2010

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