Individual ProviderJorge L GambaRadiologyAllopathic & Osteopathic PhysiciansPractice Address3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252(904) 399-5550PECOS EnrollmentBased on the most recent information from CMS, provider Jorge L Gamba does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 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