MEDICARE: JORGE L SERRA 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	ME0058799	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841287208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE L SERRA MD

Provider Business Mailing Address
First Line	:	3501 HEALTH CENTER BLVD
Second Line	:	SUITE 2190
City	:	FORT MYERS
State	:	FL
Zip	:	33908
Country	:	US
Telephone Number	:	239-221-8475
Fax Number	:	239-221-8487

Provider Business Practice Location Address
First Line	:	3501 HEALTH CENTER BLVD
Second Line	:	SUITE 2190
City	:	FORT MYERS
State	:	FL
Zip	:	33908
Country	:	US
Telephone Number	:	239-221-8475
Fax Number	:	239-221-8487

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	12/07/2009

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