Provider Demographics
NPI:1427242866
Name:SOZA, JOSE SALVADOR (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:SALVADOR
Last Name:SOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:SALVADOR
Other - Last Name:SOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11535 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1002
Mailing Address - Country:US
Mailing Address - Phone:786-595-8000
Mailing Address - Fax:786-533-9576
Practice Address - Street 1:11535 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1002
Practice Address - Country:US
Practice Address - Phone:786-595-8000
Practice Address - Fax:786-533-9576
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 107981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004436800Medicaid
FLFJ527YMedicare PIN