Provider Demographics
NPI:1326282013
Name:DE APODACA, JOSE PEREZ GONZALEZ (MD/PHD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:PEREZ GONZALEZ
Last Name:DE APODACA
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:PEREZ GONZALEZ DE APODACA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD/PHD
Mailing Address - Street 1:403 VONDERBURG DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5501
Mailing Address - Country:US
Mailing Address - Phone:813-681-1122
Mailing Address - Fax:813-684-4924
Practice Address - Street 1:403 VONDERBURG DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5501
Practice Address - Country:US
Practice Address - Phone:813-681-1122
Practice Address - Fax:813-684-4924
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436842207W00000X
FLME121607207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology