Provider Demographics
NPI:1912931429
Name:COLL, JORGE R (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:R
Last Name:COLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 BRICKELL AVE
Mailing Address - Street 2:APT A1710
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1621
Mailing Address - Country:US
Mailing Address - Phone:305-446-9155
Mailing Address - Fax:305-446-1855
Practice Address - Street 1:450 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2814
Practice Address - Country:US
Practice Address - Phone:305-860-0044
Practice Address - Fax:305-860-0171
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME70533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG80562Medicare UPIN
FLBP263AMedicare PIN
FLE8801CMedicare PIN