MEDICARE: JMG MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1164256293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMG MD LLC

Provider Business Mailing Address
First Line	:	672 CAMINO DE LAS LAVANDAS
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-6167
Country	:	US
Telephone Number	:	787-234-0509
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 CAMINO DE LAS LAVANDAS
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-6167
Country	:	US
Telephone Number	:	787-234-0509
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH MENDEZ GOMEZ II
Credential	:	MD
Telephone Number	:	787-234-0509

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/30/2024

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