Provider Demographics
NPI:1316934417
Name:SAEZ, JOSE M (DO)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:SAEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36022 TARPON DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5058
Mailing Address - Country:US
Mailing Address - Phone:302-827-2316
Mailing Address - Fax:
Practice Address - Street 1:36022 TARPON DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-5058
Practice Address - Country:US
Practice Address - Phone:302-430-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20005836207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000016712Medicaid
DE1000016712Medicaid
H93616Medicare UPIN