Provider Demographics
NPI:1831783471
Name:MEJIA, JORGE (CO LO)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MEJIA
Suffix:
Gender:M
Credentials:CO LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 NW 83RD ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5601
Mailing Address - Country:US
Mailing Address - Phone:352-331-4221
Mailing Address - Fax:352-332-8074
Practice Address - Street 1:3870 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5601
Practice Address - Country:US
Practice Address - Phone:352-331-4221
Practice Address - Fax:352-332-8074
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT351222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist