Provider Demographics
NPI:1548459423
Name:JORGE J CARRILLO MD PA
Entity type:Organization
Organization Name:JORGE J CARRILLO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-627-0990
Mailing Address - Street 1:11211 PROSPERITY FARMS RD
Mailing Address - Street 2:D127
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3446
Mailing Address - Country:US
Mailing Address - Phone:561-627-0990
Mailing Address - Fax:561-625-0248
Practice Address - Street 1:11211 PROSPERITY FARMS RD
Practice Address - Street 2:D127
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3446
Practice Address - Country:US
Practice Address - Phone:561-627-0990
Practice Address - Fax:561-625-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37325207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD82497Medicare UPIN