Provider Demographics
NPI:1821246489
Name:JORGE L SERRA MD PA
Entity Type:Organization
Organization Name:JORGE L SERRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-221-8475
Mailing Address - Street 1:3501 HEALTH CENTER BLVD
Mailing Address - Street 2:SUITE 2190
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8133
Mailing Address - Country:US
Mailing Address - Phone:239-221-8475
Mailing Address - Fax:239-221-8487
Practice Address - Street 1:3501 HEALTH CENTER BLVD
Practice Address - Street 2:SUITE 2190
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-8133
Practice Address - Country:US
Practice Address - Phone:239-221-8475
Practice Address - Fax:239-221-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty