Healthcare Provider Details

I. General information

NPI: 1508808734
Provider Name (Legal Business Name): JORGE MEJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 SUNSET DR STE 103
SOUTH MIAMI FL
33143-5198
US

IV. Provider business mailing address

5975 SUNSET DR STE 103
SOUTH MIAMI FL
33143-5198
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-4044
  • Fax: 305-667-8387
Mailing address:
  • Phone: 305-666-4044
  • Fax: 305-667-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME66319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: