Provider Demographics
NPI:1053377754
Name:BERRIOS, JOSE ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALBERTO
Last Name:BERRIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 TARPON WOODS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2011
Mailing Address - Country:US
Mailing Address - Phone:727-942-4005
Mailing Address - Fax:727-934-1773
Practice Address - Street 1:800 TARPON WOODS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2011
Practice Address - Country:US
Practice Address - Phone:727-942-4005
Practice Address - Fax:727-934-1773
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052177207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040014067OtherRR MEDICARE
02978OtherWELLCARE
0600062OtherGHI
ZA5283OtherBLUE CROSS MASSACHUSETTS
209756OtherAMERIGROUP
214676OtherAVMED
FL047382100Medicaid
7A7011OtherEMPIRE BLUE CROSS NY
593341132OtherTAX ID
FLD61176Medicare UPIN
209756OtherAMERIGROUP