Provider Demographics
NPI:1497714281
Name:JORGE A. PATINO MD, PA
Entity Type:Organization
Organization Name:JORGE A. PATINO MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:956-542-3200
Mailing Address - Street 1:5460 PAREDES LINE RD
Mailing Address - Street 2:SUITE 198
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9740
Mailing Address - Country:US
Mailing Address - Phone:956-542-3200
Mailing Address - Fax:956-504-6733
Practice Address - Street 1:5460 PAREDES LINE RD
Practice Address - Street 2:SUITE 198
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-9740
Practice Address - Country:US
Practice Address - Phone:956-542-3200
Practice Address - Fax:956-504-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6684208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092281704Medicaid
TX092281705Medicaid
TX092281708Medicaid
TX092281703Medicaid
TX092281707Medicaid
TX092281705Medicaid