Provider Demographics
NPI:1992818629
Name:GARAYUA, JORGE E (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:GARAYUA
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:PO BOX 772739
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32877-2739
Mailing Address - Country:US
Mailing Address - Phone:407-250-6002
Mailing Address - Fax:407-203-3139
Practice Address - Street 1:7758 WALLACE RD STE C&D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7219
Practice Address - Country:US
Practice Address - Phone:407-250-6002
Practice Address - Fax:407-203-3139
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97664207R00000X
PR15827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI64573Medicare UPIN