Provider Demographics
NPI:1861464562
Name:CHAMORRO, JOSE A (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:CHAMORRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2601 SW 37TH AVE
Practice Address - Street 2:STE 503
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2700
Practice Address - Country:US
Practice Address - Phone:305-446-2380
Practice Address - Fax:305-446-8243
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 45485208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL218108OtherAVMED
FL001896OtherNHP
FL1744855OtherCIGNA
FL4072662OtherAETNA
FL96934OtherBCBS
FL1896OtherDIMENSION
FLP01551OtherFREEDOM
FLP974912OtherOPTIMUM
FL96934OtherBLUE CROSS BLUE SHIELD
FLP01627843OtherRR MEDICARE
FLP01703687OtherSIMPLY
FL043415900Medicaid
FL160364OtherWELLCARE
FL4072662OtherAETNA
FL043415900Medicaid
FL96934VMedicare PIN