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General NPI Number Information
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NPI Number | 1770612855
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Entity Type | Individual
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Provider Name | JORGE GAVIRIA MD
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2500 N MILITARY TRL STE 111
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City | BOCA RATON
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State | FL
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Zip | 33431-6305
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Country | US
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Telephone | 561-353-0330
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Fax | 561-353-0104
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Provider Business Mailing Address
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Address Line | 2600 LAKE LUCIEN DR STE 180
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City | MAITLAND
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State | FL
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Zip | 32751-7235
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Country | US
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Telephone | 407-875-2080
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Fax | 407-875-0518
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME94318
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License Number State | FL
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