Provider Demographics
NPI:1992936488
Name:VALLE, JOSE RUBEN (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RUBEN
Last Name:VALLE
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 1:311 9TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5886
Mailing Address - Country:US
Mailing Address - Phone:239-624-8250
Mailing Address - Fax:239-430-7824
Practice Address - Street 1:311 9TH ST N STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5886
Practice Address - Country:US
Practice Address - Phone:239-624-8250
Practice Address - Fax:239-430-7824
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13813390200000X
FLME128149207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017508900Medicaid
FLIP168ZOtherMEDICARE
FL7D6S8OtherBCBS
FLIP168ZMedicare PIN