Provider Demographics
NPI:1093846107
Name:SUAREZ, JORGE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ANTONIO
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8090 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2902
Mailing Address - Country:US
Mailing Address - Phone:713-782-1717
Mailing Address - Fax:713-782-2151
Practice Address - Street 1:8090 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2902
Practice Address - Country:US
Practice Address - Phone:713-782-1717
Practice Address - Fax:713-782-2151
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0846966-01Medicaid
TX00K84COtherBLUE CROSS BLUE SHIELD
TX00K84COtherBLUE CROSS BLUE SHIELD
TXF38924Medicare UPIN