Provider Demographics
NPI:1356303960
Name:RINCON, JORGE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:RINCON
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:PO BOX 792424
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78279-2424
Mailing Address - Country:US
Mailing Address - Phone:210-587-7744
Mailing Address - Fax:
Practice Address - Street 1:1162 E SONTERRA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4049
Practice Address - Country:US
Practice Address - Phone:210-587-7744
Practice Address - Fax:210-745-0990
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179314301Medicaid
TX8V9840OtherBCBS
8F2647Medicare ID - Type Unspecified
TX179314301Medicaid