Doctor Name: | JORGE ENRIQUE MONROY AVELLA |
NPI Number: | 1265860225 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | ACN556 |
Business Practice Address: | 4725 Us Highway 98 S Suite 102 Lakeland, FL - 338124334 |
Business Phone Number: | 8636469191 |
Business Fax Number: | 8636465252 |
Mailing Address: | 111 Webb Dr, DAVENPORT |
State: | FL |
Postal Code: | 338373962 |
Phone Number: | 8636469191 |
Fax Number: | 8636465252 |
NPI Enumeration Date: | 10/29/2013 |
NPI Last Update Date: | 05/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ACN556 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |