Provider Demographics
NPI:1386698637
Name:VALDES, JORGE L (DPM)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:VALDES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17901 NW 5TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-704-2888
Mailing Address - Fax:954-704-0227
Practice Address - Street 1:17901 NW 5TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-704-2888
Practice Address - Fax:954-704-0227
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2687213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390463600Medicaid
FLU70128Medicare UPIN
FL390463600Medicaid