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NPI Code Detail

MEDICARE: DR. JORGE L PEREZ POLANCO MD

MEDICARE: DR. JORGE L PEREZ POLANCO 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
1207R00000XInternal Medicine PhysicianME94246FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P00288529OTHERFLRAILROAD PROVIDER NUMBER
330018OTHERFLBCBS
41865320OTHERFLCIGNA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538158761
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORGE L PEREZ POLANCO MD
Provider Business Mailing Address
First Line : PO BOX 271085
Second Line :
City : TAMPA
State : FL
Zip : 33688-1085
Country : US
Telephone Number : 407-788-1906
Fax Number : 239-574-1451
Provider Business Practice Location Address
First Line : 119 OAKFIELD DR
Second Line :
City : BRANDON
State : FL
Zip : 33511-5779
Country : US
Telephone Number : 813-681-0038
Fax Number : 239-574-1451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 12/16/2021

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Directions to “ DR. JORGE L PEREZ POLANCO MD” Practice Location

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