Individual
MR. JORGE L CORDOVA - RUIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
100 DEERFIELD PRESERVE BLVD, ST AUGUSTINE, FL 32086-5966
(904) 829-0814
Mailing address
100 DEERFIELD PRESERVE BLVD, ST AUGUSTINE, FL 32086-5966
(904) 829-0814
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
019114
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477967545
1477967545
PR
Enumeration date
06/17/2014
Last updated
03/04/2022
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