Provider Demographics
NPI:1851380513
Name:LOZANO, JORGE FEDERICO (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:FEDERICO
Last Name:LOZANO
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:PO BOX 531768
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1768
Mailing Address - Country:US
Mailing Address - Phone:956-364-0482
Mailing Address - Fax:956-364-1255
Practice Address - Street 1:902 S AIRPORT DR
Practice Address - Street 2:SUITE #3
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6644
Practice Address - Country:US
Practice Address - Phone:956-968-1617
Practice Address - Fax:956-968-3905
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177891201Medicaid
TX177891205Medicaid
TX177891203Medicaid
TXP01123659OtherMEDICARE RAILROAD
TX177891205Medicaid
TXTXB164880Medicare PIN
TXP01123659OtherMEDICARE RAILROAD
TX8D9698Medicare PIN