Provider Demographics
NPI:1902891617
Name:ERBELLA, JOSE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:ERBELLA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 2ND ST E
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1029
Mailing Address - Country:US
Mailing Address - Phone:941-896-4788
Mailing Address - Fax:941-896-4791
Practice Address - Street 1:250 2ND ST E
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1029
Practice Address - Country:US
Practice Address - Phone:941-896-4788
Practice Address - Fax:941-896-4791
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84834208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7446649OtherAETNA
FLN347764OtherSTAYWELL HEALTHEASE WELLC
FL272589400Medicaid
FL6433980OtherCIGNA
FLP00266888OtherRAIL ROAD MEDICARE
FL030480068003OtherMEDICAL MUTUAL
FL668764OtherAMERIHEALTH
FL01544OtherBCBS
FL90192OtherHEALTHPARTNERS
FL272589400Medicaid
FL668764OtherAMERIHEALTH