MEDICARE: JORGE LUIS JORGE 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	2084P0800X	Psychiatry Physician	036163674	IL
2	2084P0800X	Psychiatry Physician	150990	FL
3	2084P0800X	Psychiatry Physician	5315238935	MI
4	2084P0800X	Psychiatry Physician	ME150990	FL
5	207Q00000X	Family Medicine Physician	ME150990	FL
6	2084P0800X	Psychiatry Physician	50559	AL

General Provider Information

NPI Number	:	1366949737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUIS JORGE MD

Provider Business Mailing Address
First Line	:	1000 BRICKELL AVE STE 715-1871
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7720 SW 99TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3153
Country	:	US
Telephone Number	:	786-681-4959
Fax Number	:

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

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	02/06/2025

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