MEDICARE: DR. JIMMY CAMARGO DOURADO M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207QA0505X	Adult Medicine Physician	144038	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770014714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY CAMARGO DOURADO M.D.

Provider Business Mailing Address
First Line	:	2001 KINGSLEY AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5148
Country	:	US
Telephone Number	:	904-639-2112
Fax Number	:	904-639-2015

Provider Business Practice Location Address
First Line	:	3625 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4222
Country	:	US
Telephone Number	:	904-702-6111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	03/11/2021

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