Healthcare Provider Details

I. General information

NPI: 1851486468
Provider Name (Legal Business Name): JORGE L MACIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2023
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SE 4TH STREET
BOYNTON BEACH FL
33435-4905
US

IV. Provider business mailing address

115 SE 4TH STREET
BOYNTON BEACH FL
33435-4905
US

V. Phone/Fax

Practice location:
  • Phone: 561-732-2701
  • Fax: 561-732-0354
Mailing address:
  • Phone: 561-732-2701
  • Fax: 561-732-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0072263
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME72263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: