Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 12326 | FL |
NPI | 1295837854 |
---|---|
Provider Name | Rolando Jorge III |
First Address | Pompano Beach, FL 33062-4238 |
Second Address | Pompano Beach, FL 33062-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 08/07/2007 |