Provider Demographics
NPI:1659476463
Name:ISAAC, JORGE CESAR (MD,)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:CESAR
Last Name:ISAAC
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 1:753 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3054
Mailing Address - Country:US
Mailing Address - Phone:843-284-3400
Mailing Address - Fax:843-284-3401
Practice Address - Street 1:360 E 4500 S
Practice Address - Street 2:# 4
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3992
Practice Address - Country:US
Practice Address - Phone:801-266-0055
Practice Address - Fax:801-266-0056
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT374897-1205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT374897-1205OtherUT MEDICAL LICENSE
LAMD.12025ROtherLA MEDICAL LICENSE #
FLME77122OtherFL MEDICAL LICENSE #
AL00018771OtherAL MEDICAL LICENSE #
G62673Medicare UPIN