Individual
DR. JOSE ANTONIO PAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2595 TAMPA RD STE G, PALM HARBOR, FL 34684-3130
(727) 781-3448
(866) 777-2195
Mailing address
8145 CEREBELLUM WAY, SUITE 101, TRINITY, FL 34655-1788
(727) 781-3448
(866) 777-2195
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
ME0040616
FL
207VG0400X
Gynecology Physician
Primary
ME0040616
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001553500
GROUP MEDICAID
FL
05
—
067804000
—
FL
01
—
1386823243
GROUP NPI
FL
01
—
260609255
GROUP TAX ID
FL
01
—
BC538A
GROUP MEDICARE PALM HARBOR
FL
01
—
BC538G
GROUP MEDICARE NEW PORT RICHEY
FL
Enumeration date
10/04/2006
Last updated
01/10/2017
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