Provider Demographics
NPI:1215049200
Name:TOLEDO, JOSE RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAFAEL
Last Name:TOLEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-223-5345
Mailing Address - Fax:772-223-0960
Practice Address - Street 1:827 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2401
Practice Address - Country:US
Practice Address - Phone:772-223-5345
Practice Address - Fax:772-223-0960
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00604372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055716100Medicaid
FL12656Medicare ID - Type Unspecified