Provider Demographics
NPI:1942397583
Name:JORGE CASAS GANEM MD PA
Entity Type:Organization
Organization Name:JORGE CASAS GANEM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAS GANEM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:214-691-9777
Mailing Address - Street 1:8230 WALNUT HILL LN
Mailing Address - Street 2:SUITE 514
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4482
Mailing Address - Country:US
Mailing Address - Phone:214-691-9777
Mailing Address - Fax:214-691-1123
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:SUITE 514
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:214-691-9777
Practice Address - Fax:214-691-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2174207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSOther0077NX
TX191642101Medicaid
TX00X083Medicare PIN