Provider Demographics
NPI:1487112181
Name:IDONE, JOSE A (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:IDONE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21378 MARINA COVE CIR APT B19
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3562
Mailing Address - Country:US
Mailing Address - Phone:305-570-7575
Mailing Address - Fax:
Practice Address - Street 1:21378 MARINA COVE CIR APT B19
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3562
Practice Address - Country:US
Practice Address - Phone:305-570-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111973363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant