Individual
DR. JOSE ENRIQUE IRAZUZTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 PRUDENTIAL DR, UFJP PEDIATRIC CRITICAL CARE MEDICINE, JACKSONVILLE, FL 32207-8202
(904) 202-8758
(904) 306-9884
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME92195
FL
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME92195
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
229619568A
—
GA
05
—
2716038-00
—
FL
Enumeration date
03/29/2006
Last updated
03/30/2010
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