Provider Demographics
NPI:1417967886
Name:NASR, JORGE F (DPM)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:F
Last Name:NASR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NW 27 ST
Mailing Address - Street 2:STE 108
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1906
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:11760 BIRD RD
Practice Address - Street 2:SUITE #529
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8105
Practice Address - Country:US
Practice Address - Phone:305-220-3636
Practice Address - Fax:305-220-3640
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2129213ES0103X
GAPOD 1025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA733822071AMedicaid
FL390008800Medicaid
FLU08969Medicare UPIN
FL65151DMedicare PIN
FL65151Medicare ID - Type UnspecifiedMEDICAR PROVIDER NUMBER