Provider Demographics
NPI:1225031289
Name:MENENDEZ, JORGE LUIS (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91199
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-9097
Mailing Address - Country:US
Mailing Address - Phone:210-829-7411
Mailing Address - Fax:210-829-7899
Practice Address - Street 1:7744 BROADWAY ST
Practice Address - Street 2:STE 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3262
Practice Address - Country:US
Practice Address - Phone:210-829-7411
Practice Address - Fax:210-829-7899
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG8281208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery