Provider Demographics
NPI:1003874553
Name:JORGE A AGUILAR MD PA
Entity Type:Organization
Organization Name:JORGE A AGUILAR MD PA
Other - Org Name:JORGE JACKSONVILLE CO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-241-8300
Mailing Address - Street 1:905 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-241-8300
Mailing Address - Fax:904-241-0831
Practice Address - Street 1:905 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-241-8300
Practice Address - Fax:904-241-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1966OtherMEDICARE GROUP
FL45775OtherBCBS GROUP
FL049551400Medicaid
FL69933OtherAETNA GROUP
FL45775OtherBCBS GROUP
FLK1966OtherMEDICARE GROUP
FL69933OtherAETNA GROUP