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Jorge L Gamba

Radiology

Allopathic & Osteopathic Physicians

3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252

PECOS Enrollment

This 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 B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1700803376
Provider Type
Individual
Full Name
Gamba, Jorge L
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
7/17/2006
Last Updated
8/21/2017

Contact Information

Practice Location

3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252

(904) 399-5550

(904) 346-4334

Mailing Location

3599 University Blvd S, Building 300, Jacksonville, FL 32216-4252

(904) 399-5550

(904) 346-4334

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License ME47983 Florida

Provider Identifiers

ID	Description	Issuer
ID 047684600	Description Medicaid	Issuer Unlisted Florida
ID 14169	Description Other	Issuer BCBS Florida
ID 00360115A	Description Medicaid	Issuer Unlisted Georgia

Jorge L Gamba

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Medical Diagnostic Center Of Jacksonville

Latour, Emile A

Rodriguez, Francisco J

Rmed Llc

Fields, Marcus S

Buxton, Richard C

Schallen, Eric H

Alderman, Mary

Altec Diagnostics & Imaging Inc

Thirumala, Krishna D