Provider Demographics
NPI:1164535191
Name:MUNOZ, JORGE (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-3534
Mailing Address - Country:US
Mailing Address - Phone:830-426-7444
Mailing Address - Fax:830-426-7471
Practice Address - Street 1:3200 AVENUE E
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3525
Practice Address - Country:US
Practice Address - Phone:830-426-7444
Practice Address - Fax:830-426-7471
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U70WOtherBLUECROSS & BLUE SHIELD
TX100355001Medicaid
TX00U70WOtherBLUECROSS & BLUE SHIELD
TX00U70WMedicare PIN