DR. JOSE ALBERTO ETTEDGUI M.D.
NPI 1316915663
Pediatrics - Pediatric Cardiology in Jacksonville, FL

Q: What is Jose Ettedgui's NPI number?

The NPI number for Jose Ettedgui is 1316915663. It was assigned to this individual provider in the NPPES registry on March 12, 2006.

Q: What is Jose Ettedgui's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Cardiology, with taxonomy code 2080P0202X.

Q: When was this NPI record last updated?

The NPPES record for Jose Ettedgui was last updated on May 11, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 12, 2006PECOS Enrolled

841 PRUDENTIAL DR STE 280, JACKSONVILLE, FL 32207(904) 202-8550(904) 393-7808 Get Directions Write a Review

NPPES record last updated: May 11, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Dr. Jose Alberto Ettedgui M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JOSE ALBERTO ETTEDGUI M.D. (NPI 1316915663) is an individual pediatric cardiology provider in Jacksonville, Florida, licensed in Florida (ME86378) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1316915663

Entity TypeIndividualMale

Primary Taxonomy2080P0202X

Provider Legal NameDR. JOSE ALBERTO ETTEDGUICredential: M.D.

Location Address841 PRUDENTIAL DR STE 280Jacksonville, FL 32207-8350

Mailing AddressPo Box 40767Jacksonville, FL 32203-0767 · (904) 376-3707

Phone(904) 202-8550

Fax(904) 393-7808

Sole ProprietorNo

Enumeration DateMarch 12, 2006

Last NPPES UpdateMay 11, 2023

NPPES CertifiedMay 11, 2023

✔ NPI 1316915663 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric CardiologyAllopathic & Osteopathic Physicians

Taxonomy Code2080P0202X

License✔ Licensed in FL · ME86378

Definition

A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease.

Also ListedPediatricsTaxonomy 208000000X · License ME86378 (FL)

841 PRUDENTIAL DR STE 280, Jacksonville, FL 32207

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Other Identifiers 2

Medicaid2637286-00FL

Medicaid000723269AGA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jose Alberto Ettedgui M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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