Provider Demographics
NPI:1306823661
Name:ARZAC, JORGE ARTURO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ARTURO
Last Name:ARZAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:ARTURO
Other - Last Name:ARZAC-RIQUELME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 W COLORADO BLVD STE 728
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2357
Mailing Address - Country:US
Mailing Address - Phone:214-941-0100
Mailing Address - Fax:214-941-7024
Practice Address - Street 1:221 W COLORADO BLVD STE 728
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2357
Practice Address - Country:US
Practice Address - Phone:214-941-0100
Practice Address - Fax:214-941-7024
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9954207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
895989OtherAMERICAN BOARD OF OBSTETRICS AND GYNECOLOGY
TX100308901Medicaid
TXJ9954OtherPHYSICIAN PERMIT
TX100308905Medicaid
TX10095164OtherCONTROLLED SUBSTANCES REG
TX100308901Medicaid
TXJ9954OtherPHYSICIAN PERMIT
TX100308905Medicaid