Individual
DR. JOSE M NIETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4200 SUN N LAKE BLVD, SEBRING, FL 33872-1986
(863) 402-3103
Mailing address
4200 SUN N LAKE BLVD, SEBRING, FL 33872-1986
(863) 402-3103
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
20A8097
CA
207RG0100X
Gastroenterology Physician
Primary
OS10072
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16365
BCBS FL
FL
05
—
279200100
—
FL
Enumeration date
12/15/2006
Last updated
02/08/2023
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