Provider Demographics
NPI:1093973661
Name:MASSARE-RODRIGUEZ, JORGE EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:EDUARDO
Last Name:MASSARE-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:EDUARDO
Other - Last Name:MASSARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19036
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4085
Mailing Address - Country:US
Mailing Address - Phone:903-381-7263
Mailing Address - Fax:903-381-7269
Practice Address - Street 1:709 HOLLYBROOK DR
Practice Address - Street 2:SUITE 2301
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2411
Practice Address - Country:US
Practice Address - Phone:903-757-5804
Practice Address - Fax:903-232-2888
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7577174400000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205353003Medicaid
TX205353003Medicaid