Organization
JOSE R. FORADADA, III, MD, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE RAMON FORADADA III M.D. (PRESIDENT)
(813) 874-2000
Entity
Organization
Contact information
Practice address
4710 N. HABANA AVE., SUITE 307, TAMPA, FL 33614-7151
(813) 874-2000
Mailing address
4710 N. HABANA AVE., SUITE 307, TAMPA, FL 33614-7151
(813) 874-2000
(813) 874-9303
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
ME0056885
FL
363LP0200X
Pediatric Nurse Practitioner
ARNP3390982
FL
363LP0200X
Pediatric Nurse Practitioner
ARNP9263175
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062490000
—
FL
01
—
273113400
MEDICAID GROUP
FL
Enumeration date
11/15/2012
Last updated
11/15/2012
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