Provider Demographics
NPI:1043206980
Name:DUCHICELA, JORGE A (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:DUCHICELA
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 1:402 YOUENS DR
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:TX
Mailing Address - Zip Code:78962-3680
Mailing Address - Country:US
Mailing Address - Phone:979-725-8545
Mailing Address - Fax:979-725-8287
Practice Address - Street 1:402 YOUENS DR
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:TX
Practice Address - Zip Code:78962-3680
Practice Address - Country:US
Practice Address - Phone:979-725-8545
Practice Address - Fax:979-725-8287
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8669B9Medicare PIN
TXC15408Medicare UPIN