MEDICARE: JORGE R GUZMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME72957	FL

General Provider Information

NPI Number	:	1043228091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE R GUZMAN MD

Provider Business Mailing Address
First Line	:	3501 HEALTH CENTER BLVD
Second Line	:	#2160
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135
Country	:	US
Telephone Number	:	239-948-4470
Fax Number	:	239-948-0933

Provider Business Practice Location Address
First Line	:	3501 HEALTH CENTER BLVD
Second Line	:	#2160
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135
Country	:	US
Telephone Number	:	239-948-4470
Fax Number	:	239-948-0933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	03/24/2015

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