Healthcare Provider Details

I. General information

NPI: 1083068894
Provider Name (Legal Business Name): ERIC AUSTIN JORGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SOUTHERN BLVD
LOXAHATCHEE FL
33470-9203
US

IV. Provider business mailing address

1084 EGRET CIR N
JUPITER FL
33458-8313
US

V. Phone/Fax

Practice location:
  • Phone: 561-345-7009
  • Fax:
Mailing address:
  • Phone: 561-676-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.35659
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number154838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: