Provider Demographics
NPI:1073567640
Name:LOREDO, JORGE ALBERTO (DO)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ALBERTO
Last Name:LOREDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 SW 27TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1243
Mailing Address - Country:US
Mailing Address - Phone:786-409-2407
Mailing Address - Fax:877-809-5936
Practice Address - Street 1:1312 SW 27TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1243
Practice Address - Country:US
Practice Address - Phone:786-409-2407
Practice Address - Fax:877-809-5936
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72605OtherBCBS