Provider Demographics
NPI:1639300536
Name:VALDIVIA, JORGE A (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:VALDIVIA
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 1:1000 CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:816-943-4758
Mailing Address - Fax:816-943-4757
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:816-943-4758
Practice Address - Fax:816-943-4757
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35968207R00000X, 208M00000X
MO2016043564208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002408OtherMEDICARE PTAN