MEDICARE: DR. JORGE J CALLE MEDINA M.D.

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	208M00000X	Hospitalist Physician	ME 112994	FL
2	207R00000X	Internal Medicine Physician	ME 112994	FL

General Provider Information

NPI Number	:	1598026569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE J CALLE MEDINA M.D.

Provider Business Mailing Address
First Line	:	4670 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-5640
Country	:	US
Telephone Number	:	561-433-8900
Fax Number	:	561-433-4117

Provider Business Practice Location Address
First Line	:	3715 LAKE WORTH RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4033
Country	:	US
Telephone Number	:	561-433-8817
Fax Number	:	561-433-1243

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	03/12/2021

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