Provider Demographics
NPI:1447390729
Name:JORGE R VALENCIA M.D.
Entity Type:Organization
Organization Name:JORGE R VALENCIA M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-322-1313
Mailing Address - Street 1:1505 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-1438
Mailing Address - Country:US
Mailing Address - Phone:940-692-6817
Mailing Address - Fax:
Practice Address - Street 1:5 EUREKA CIR
Practice Address - Street 2:SUITE C
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2900
Practice Address - Country:US
Practice Address - Phone:940-322-1313
Practice Address - Fax:940-322-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0049HUOtherBCBS OF TEX PROVIDER ID
TX=========OtherTAXID NUMBER
TX00526MMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID NUMB
TX=========OtherTAXID NUMBER