Provider Demographics
NPI:1790787000
Name:CORZO, JORGE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:E
Last Name:CORZO
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:TIERRA ALTA III I-14 RUISENOR ST
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3347
Mailing Address - Country:US
Mailing Address - Phone:787-781-0059
Mailing Address - Fax:787-273-1722
Practice Address - Street 1:1789 CARR 21 STE 306
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3337
Practice Address - Country:US
Practice Address - Phone:787-781-0059
Practice Address - Fax:787-273-1722
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08353Medicare UPIN
PR0026015Medicare ID - Type UnspecifiedPHYSICIAN