Individual ProviderJorge L GambaRadiologyAllopathic & Osteopathic PhysiciansPractice Address3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252(904) 399-5550PECOS EnrollmentThis provider is enrolled in PECOS as JORGE GAMBA.Based on the most recent information from CMS, provider Jorge L Gamba is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 7 days ago.Profile DetailsProvider ID1700803376Provider TypeIndividualFull NameGamba, Jorge LCredentialMDGenderMaleSole ProprietorNoEnumeration Date7/17/2006Last Updated8/21/2017Contact InformationPractice LocationPractice Address3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252Phone(904) 399-5550Fax(904) 346-4334Mailing LocationMailing Address3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252Phone(904) 399-5550Fax(904) 346-4334Provider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseME47983FloridaProvider IdentifiersIDDescriptionIssuerID047684600DescriptionMedicaidIssuerUnlistedFloridaID14169DescriptionOtherIssuerBCBSFloridaID00360115ADescriptionMedicaidIssuerUnlistedGeorgia