Provider Demographics
NPI:1861441156
Name:JORGE, JULIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:
Last Name:JORGE
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 1:9560 SW 107TH AVE
Mailing Address - Street 2:SUITE A104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2787
Mailing Address - Country:US
Mailing Address - Phone:305-596-1913
Mailing Address - Fax:
Practice Address - Street 1:9560 SW 107TH AVE
Practice Address - Street 2:SUITE A104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2787
Practice Address - Country:US
Practice Address - Phone:305-596-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374737900Medicaid
FL23920AMedicare ID - Type Unspecified