Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ACN838 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | ACN838 | FL |
N | 208D00000X | General Practice Physician | 12736 | PR |
N | 208D00000X | General Practice Physician | ACN838 | FL |
NPI | 1851382881 |
---|---|
Provider Name | Dr. Jose E Piovanetti JR. |
First Address | Oviedo, FL 32765-9092 |
Second Address | Orlando, FL 32822-8201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12736 | STATE LICENSE (01) | PR |
ACN838 | FLORIDA MEDICAL BOARD (01) | FL |
BP5723970 | DEA (01) | PR |
DM-12593-3 | STATE CONTROL SUBS. LIC. (01) | PR |
FP4905874 | DEA (01) | FL |
XP4905874 | DEA (01) | FL |