Provider Demographics
NPI:1194791202
Name:ARIAS JR., JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:ARIAS JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:R
Other - Last Name:ARIAS JR.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-339-3002
Mailing Address - Fax:407-260-5039
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 315
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-339-3002
Practice Address - Fax:407-260-5039
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80622174400000X
FL80622207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270739000Medicaid
FLH23510Medicare UPIN
FL270739000Medicaid