Provider Demographics
NPI:1679531115
Name:AGUILAR, JORGE A (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:940-241-0831
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:940-241-0831
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07706OtherBCBS
FL4197769OtherAETNA
FL049551400Medicaid
FL07706OtherBCBS
FL077064Medicare ID - Type Unspecified