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NPI Code Detail

MEDICARE: JORGE C ANTUNEZ DE MAYOLO MD

MEDICARE: JORGE C ANTUNEZ DE MAYOLO 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
1207RH0003XHematology & Oncology PhysicianME47826FL
2207RH0003XHematology & Oncology PhysicianME0047826FL

General Provider Information

NPI Number : 1407844798
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE C ANTUNEZ DE MAYOLO MD
Provider Business Mailing Address
First Line : PO BOX 746654
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6654
Country : US
Telephone Number : 904-202-2092
Fax Number : 904-376-4075
Provider Business Practice Location Address
First Line : 1301 PALM AVE STE 600
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8457
Country : US
Telephone Number : 904-202-7300
Fax Number : 904-202-2754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 04/28/2025

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