Individual ProviderJuan C. Luis-JorgeRadiologyAllopathic & Osteopathic PhysiciansPractice Address4933 University Blvd W, Jacksonville, FL 32216-5935(904) 733-7800(904) 398-9951PECOS EnrollmentBased on the most recent information from CMS, provider Juan C. Luis-Jorge 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 10 days ago.Profile DetailsProvider ID1992736797Provider TypeIndividualFull NameLuis-Jorge, Juan C.TitleDr.CredentialM.D.GenderMaleSole ProprietorYesEnumeration Date7/6/2006Last Updated2/19/2013Contact InformationPractice LocationPractice Address4933 University Blvd W, Jacksonville, FL 32216-5935Phone(904) 733-7800Fax(904) 419-4888Mailing LocationMailing Address4114 Alhambra Dr W, Jacksonville, FL 32207-6017Phone(904) 398-9951Fax(904) 398-9875Provider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseME52228FloridaCode174400000XDescriptionSpecialistOther Service ProvidersLicenseME0052228FloridaProvider IdentifiersIDDescriptionIssuerID049288400DescriptionMedicaidIssuerUnlistedFlorida