Provider Demographics
NPI:1710026596
Name:DE LA CHAPA, JORGE ADRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ADRIAN
Last Name:DE LA CHAPA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 N LOOP 1604 W
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2810 N LOOP 1604 W
Practice Address - Street 2:STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2230
Practice Address - Country:US
Practice Address - Phone:210-822-9800
Practice Address - Fax:210-822-9810
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9252207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45831701Medicaid
TX45831701Medicaid
TX8790J2Medicare ID - Type Unspecified