Provider Demographics
NPI:1356516835
Name:JORGE L BARROS MD PA
Entity type:Organization
Organization Name:JORGE L BARROS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BARROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-431-7323
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-431-7323
Mailing Address - Fax:954-435-1658
Practice Address - Street 1:601 NORTH FLAMINGO ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-431-7323
Practice Address - Fax:954-435-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373633400Medicaid
FL373633400Medicaid
15077Medicare PIN