Provider Demographics
NPI:1528090834
Name:CARDONA, JERGES J (MD)
Entity type:Individual
Prefix:DR
First Name:JERGES
Middle Name:J
Last Name:CARDONA
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 1:2810 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1853
Mailing Address - Country:US
Mailing Address - Phone:813-935-5501
Mailing Address - Fax:813-933-8784
Practice Address - Street 1:2810 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1853
Practice Address - Country:US
Practice Address - Phone:813-935-5501
Practice Address - Fax:813-933-8784
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069539174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49139OtherBCBS
FL290014532OtherRR MEDICARE
FL200439OtherWELLCARE
FL263649OtherAVMED
FL259800100Medicaid
FL200439OtherWELLCARE
FL263649OtherAVMED