Provider Demographics
NPI:1295012946
Name:JORGE A. SALDIVAR MD PA
Entity Type:Organization
Organization Name:JORGE A. SALDIVAR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-780-8009
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:75115-2078
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty