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 yesterday at 11:51 AM.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