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 1:8550 DATAPOINT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3270
Mailing Address - Country:US
Mailing Address - Phone:210-615-8308
Mailing Address - Fax:210-615-8313
Practice Address - Street 1:8550 DATAPOINT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3270
Practice Address - Country:US
Practice Address - Phone:210-615-8308
Practice Address - Fax:210-615-8313
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100355001Medicaid
TX00U70WOtherBLUECROSS & BLUE SHIELD
TX00U70WOtherBLUECROSS & BLUE SHIELD
TX00U70WMedicare PIN