Provider Demographics
NPI:1821005331
Name:SARMIENTO, JORGE LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:SARMIENTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10501 GATEWAY BLVD W
Mailing Address - Street 2:STE 101
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7929
Mailing Address - Country:US
Mailing Address - Phone:915-225-2480
Mailing Address - Fax:915-315-2481
Practice Address - Street 1:10501 GATEWAY BLVD W
Practice Address - Street 2:STE 101
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7929
Practice Address - Country:US
Practice Address - Phone:915-225-2480
Practice Address - Fax:915-315-2481
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP54672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184007607Medicaid
387683AH8EOtherMEDICARE