Jose F Eduardo, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN15816 Issued in FL

Practice address

1381 S Patrick Dr
45TH Medical Group
Patrick AFB, FL 32925

Phone

(321) 494-6366

Fax

(321) 494-1378

NPI assigned

Sep 26, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Freedom Health HMO Network

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033105986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 AUBURN LAKES DR",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "32955",
            "telephone_number": "321-636-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 S PATRICK DR",
            "address_2": "45TH MEDICAL GROUP",
            "city": "PATRICK AFB",
            "state": "FL",
            "postal_code": "32925",
            "telephone_number": "321-494-6366",
            "fax_number": "321-494-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDUARDO",
        "first_name": "JOSE",
        "middle_name": "F",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN15816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Minal S Desai, MD
• Emanuel Diaz, MD
• Glenn Donnelly, D.O., MPH
• Paul Drylewski, R.PH.
• Randy W Dutton, OPTOMETRIST
• Jade Esmailzadeh, R.D., LDN
• David M Farrell, PT
• Charles William Fetrow, PHARMD
• Brenda E Flynn, MSW, LCSW
• April Mae Garnish, RDH

• Dentist in Patrick AFB, FL
• Providers in Patrick AFB, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.