Provider Demographics
NPI:1902110240
Name:JOSE, ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:JOSE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:6420 CLAYTON ROAD
Mailing Address - Street 2:SSM ST MARYS HEALTH CENTER/ DEPT OF INTERNAL MEDICINE
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1872
Mailing Address - Country:US
Mailing Address - Phone:314-768-8778
Mailing Address - Fax:314-768-7101
Practice Address - Street 1:6420 CLAYTON ROAD
Practice Address - Street 2:SSM ST MARYS HEALTH CENTER/ DEPT OF INTERNAL MEDICINE
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1872
Practice Address - Country:US
Practice Address - Phone:314-768-8778
Practice Address - Fax:314-768-7101
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010014288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine