Provider Demographics
NPI:1326124231
Name:INGA, JORGE JAIME (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:JAIME
Last Name:INGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:JAIME
Other - Last Name:INGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:6701 HANLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4742
Mailing Address - Country:US
Mailing Address - Phone:813-888-5000
Mailing Address - Fax:813-888-9608
Practice Address - Street 1:6701 HANLEY ROAD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4742
Practice Address - Country:US
Practice Address - Phone:813-888-5000
Practice Address - Fax:813-888-9608
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031812207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D53869Medicare UPIN
FL30129Medicare ID - Type Unspecified