Provider Demographics
NPI:1497147888
Name:JORGE G LODEIRO MD PA
Entity Type:Organization
Organization Name:JORGE G LODEIRO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LODEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-832-2860
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6496
Practice Address - Street 1:3270 JOE BATTLE BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2639
Practice Address - Country:US
Practice Address - Phone:915-832-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0085207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty