Provider Demographics
NPI:1720165012
Name:JORGE, ALLAN M (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:M
Last Name:JORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6705 S RED RD
Mailing Address - Street 2:#522
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3622
Mailing Address - Country:US
Mailing Address - Phone:786-517-8650
Mailing Address - Fax:
Practice Address - Street 1:6705 S RED RD
Practice Address - Street 2:#522
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3622
Practice Address - Country:US
Practice Address - Phone:786-517-8650
Practice Address - Fax:786-517-8657
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90546207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271446900Medicaid
FLU3344Medicare PIN
FLI 16847Medicare UPIN