Individual
DR. JORGE JUAN BACALLAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5858 SW 68TH ST, SOUTH MIAMI, FL 33143-3693
(305) 661-8588
(305) 661-4906
Mailing address
5858 SW 68TH ST, SOUTH MIAMI, FL 33143-3693
(305) 661-8588
(305) 661-4906
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME 92076
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268789500
—
FL
Enumeration date
07/31/2006
Last updated
02/15/2018
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