Healthcare Provider Details

I. General information

NPI: 1295924330
Provider Name (Legal Business Name): JORGE GUERRERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 OAK ST
MELBOURNE FL
32901-3111
US

IV. Provider business mailing address

1314 OAK ST
MELBOURNE FL
32901-3111
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-1100
  • Fax: 407-649-8677
Mailing address:
  • Phone: 407-841-1100
  • Fax: 407-649-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME113775
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME113775
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME113775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: