Provider Demographics
NPI:1639127335
Name:ISAZA, JORGE EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:EDUARDO
Last Name:ISAZA
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 1:10629 HILLARY CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2842
Mailing Address - Country:US
Mailing Address - Phone:225-769-3993
Mailing Address - Fax:225-448-3667
Practice Address - Street 1:10629 HILLARY CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2842
Practice Address - Country:US
Practice Address - Phone:225-769-3993
Practice Address - Fax:225-448-3667
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07385R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1389439Medicaid
LA1389439Medicaid
LA5J854Medicare ID - Type Unspecified