Individual
JORGE MANUEL GOMEZ VIZCARRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 SW SAINT LUCIE WEST BLVD STE 209, PORT ST LUCIE, FL 34986-1735
(772) 204-8889
(772) 204-8895
Mailing address
5400 PINEHURST DR, SPRING HILL, FL 34606-3833
(352) 277-5348
(352) 606-2857
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
21111
PR
208D00000X
General Practice Physician
Primary
ACN1356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111375300
—
FL
Enumeration date
11/19/2018
Last updated
03/28/2025
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