MEDICARE: JORGE LUIS CAMBO 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	ME48428	FL
2	207P00000X	Emergency Medicine Physician	ME48428	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61529	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417924812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUIS CAMBO MD

Provider Business Mailing Address
First Line	:	303 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2709
Country	:	US
Telephone Number	:	386-226-4590
Fax Number	:	386-226-3371

Provider Business Practice Location Address
First Line	:	3300 E HALIFAX CROSSING BLVD
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-2911
Country	:	US
Telephone Number	:	386-425-6100
Fax Number	:	386-425-6101

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	10/10/2018

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