Provider Demographics
NPI:1356383384
Name:CABALLERO, JORGE BANO (DO)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:BANO
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 BEACH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2643
Mailing Address - Country:US
Mailing Address - Phone:904-246-2752
Mailing Address - Fax:904-246-2758
Practice Address - Street 1:1909 BEACH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2643
Practice Address - Country:US
Practice Address - Phone:904-246-2752
Practice Address - Fax:904-246-2758
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275984500Medicaid
FLU7968WOtherMEDICARE
FL275984500Medicaid