MEDICARE: DR. JOSE ERBELLA JR. 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
1	208600000X	Surgery Physician	ME84834	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00266888	OTHER	FL	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7446649	OTHER	FL	AETNA
2	N347764	OTHER	FL	STAYWELL HEALTHEASE WELLC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	6433980	OTHER	FL	CIGNA
6	030480068003	OTHER	FL	MEDICAL MUTUAL
7	668764	OTHER	FL	AMERIHEALTH
8	01544	OTHER	FL	BCBS
9	90192	OTHER	FL	HEALTHPARTNERS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902891617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ERBELLA JR. MD

Provider Business Mailing Address
First Line	:	250 2ND ST E
Second Line	:	SUITE 1A
City	:	BRADENTON
State	:	FL
Zip	:	34208-1029
Country	:	US
Telephone Number	:	941-896-4788
Fax Number	:	941-896-4791

Provider Business Practice Location Address
First Line	:	250 2ND ST E
Second Line	:	SUITE 1A
City	:	BRADENTON
State	:	FL
Zip	:	34208-1029
Country	:	US
Telephone Number	:	941-896-4788
Fax Number	:	941-896-4791

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	01/20/2022

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