MEDICARE: DR. JORGE PAOLI-BRUNO 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	207Q00000X	Family Medicine Physician	12292	PR
2	207Q00000X	Family Medicine Physician	ME 110249	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	:	1982601159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE PAOLI-BRUNO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 227113
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33222-7113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7911 NW 72ND AVE STE 109B
Second Line	:
City	:	MEDLEY
State	:	FL
Zip	:	33166-2221
Country	:	US
Telephone Number	:	305-887-1005
Fax Number	:	305-887-1092

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

Provider Enumeration Date	:	07/03/2005
Last Update Date	:	11/11/2024

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