MEDICARE: DR. JORGE L MACIA 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	207Q00000X	Family Medicine Physician	ME0072263	FL
2	207Q00000X	Family Medicine Physician	ME72263	FL

General Provider Information

NPI Number	:	1851486468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE L MACIA MD

Provider Business Mailing Address
First Line	:	115 SE 4TH STREET
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-4905
Country	:	US
Telephone Number	:	561-732-2701
Fax Number	:	561-732-0354

Provider Business Practice Location Address
First Line	:	115 SE 4TH STREET
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-4905
Country	:	US
Telephone Number	:	561-732-2701
Fax Number	:	561-732-0354

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/07/2023

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