Provider Demographics
NPI:1376743724
Name:JORGE CONTRERAS MD LLC
Entity Type:Organization
Organization Name:JORGE CONTRERAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JORGE CONTRERAS
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-885-3272
Mailing Address - Street 1:3800 HOUMA BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5013
Mailing Address - Country:US
Mailing Address - Phone:504-885-3272
Mailing Address - Fax:504-456-6600
Practice Address - Street 1:3800 HOUMA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5013
Practice Address - Country:US
Practice Address - Phone:504-885-3272
Practice Address - Fax:504-456-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1496430Medicaid
IAH17463Medicare UPIN
IA1496430Medicaid