Provider Demographics
NPI:1841232923
Name:BROTHERS, JORGE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:R
Last Name:BROTHERS
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 1:418 N UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3035
Mailing Address - Country:US
Mailing Address - Phone:806-771-5882
Mailing Address - Fax:806-687-9002
Practice Address - Street 1:418 N UTICA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3035
Practice Address - Country:US
Practice Address - Phone:806-771-5882
Practice Address - Fax:806-687-9002
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1048208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000V8925Medicaid
TX115761207Medicaid
TX8W8990OtherBLUE CROSS BLUE SHIELD TEXAS
NM349723302Medicare PIN
TX8F4845Medicare PIN
C13815Medicare UPIN
TXP00390742Medicare PIN