Provider Demographics
NPI:1649362849
Name:CORONEL, JORGE A (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:CORONEL
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:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-596-5007
Mailing Address - Fax:
Practice Address - Street 1:8940 N KENDALL DR STE 901E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2176
Practice Address - Country:US
Practice Address - Phone:786-596-5007
Practice Address - Fax:786-596-7998
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09068OtherBLUE CROSS BLUE SHIELD
FL263768500Medicaid
FL279920OtherAVMED
FLH47491Medicare UPIN
FLE6144YMedicare PIN
FL263768500Medicaid