Provider Demographics
NPI:1457308157
Name:CASO, JORGE T (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:T
Last Name:CASO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 SW 113TH COURT CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2628
Mailing Address - Country:US
Mailing Address - Phone:305-297-0170
Mailing Address - Fax:
Practice Address - Street 1:9260 SUNSET DR STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3255
Practice Address - Country:US
Practice Address - Phone:305-297-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261714500Medicaid
FLME87967OtherMEDICAL LICENSE NUMBER
FLME87967OtherMEDICAL LICENSE NUMBER
FLH70320Medicare UPIN