Healthcare Provider Details

I. General information

NPI: 1376766287
Provider Name (Legal Business Name): JORGE ENRIQUE HIDALGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 S RED RD SUITE 304
SOUTH MIAMI FL
33143-5428
US

IV. Provider business mailing address

7600 S RED RD SUITE 304
SOUTH MIAMI FL
33143-5428
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-3911
  • Fax: 305-661-1874
Mailing address:
  • Phone: 305-665-3911
  • Fax: 305-661-1874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME40083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: