Provider Demographics
NPI:1093702128
Name:CARDENAS, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CARDENAS
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:PO BOX 8148
Mailing Address - Street 2:2311 KY AVENUE
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8148
Mailing Address - Country:US
Mailing Address - Phone:270-443-8425
Mailing Address - Fax:270-442-3303
Practice Address - Street 1:2311 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3243
Practice Address - Country:US
Practice Address - Phone:270-443-8425
Practice Address - Fax:270-442-3303
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31698207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY16002683AOtherRAILROAD MEDICARE
KY000000044377OtherANTHEM BCBS
KY64316987Medicaid
KY16002683AOtherRAILROAD MEDICARE
KYE71629Medicare UPIN