Provider Demographics
NPI:1790797074
Name:BARCENAS, JORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:M
Last Name:BARCENAS
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 1:14687 SW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2977
Mailing Address - Country:US
Mailing Address - Phone:305-383-3372
Mailing Address - Fax:305-387-7366
Practice Address - Street 1:14687 SW 104TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2977
Practice Address - Country:US
Practice Address - Phone:305-383-3372
Practice Address - Fax:305-387-7366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042122700Medicaid
FL042122700Medicaid
FL96667PMedicare ID - Type Unspecified