Provider Demographics
NPI:1285632851
Name:SALDIVAR, JORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:SALDIVAR
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 1:2715 BOLTON BOONE DR
Mailing Address - Street 2:STE B
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2079
Mailing Address - Country:US
Mailing Address - Phone:972-780-8009
Mailing Address - Fax:972-780-6115
Practice Address - Street 1:2715 BOLTON BOONE DR
Practice Address - Street 2:STE B
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2078
Practice Address - Country:US
Practice Address - Phone:972-780-8009
Practice Address - Fax:972-780-6115
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2011-11-11
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
TXF9110207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology