Provider Demographics
NPI:1134154172
Name:MAGALLON, JORGE CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:CARLOS
Last Name:MAGALLON
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 1:12446 WEST AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2517
Mailing Address - Country:US
Mailing Address - Phone:210-525-1668
Mailing Address - Fax:
Practice Address - Street 1:311 CAMDEN ST
Practice Address - Street 2:STE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2012
Practice Address - Country:US
Practice Address - Phone:210-281-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226745207R00000X
NY244808207RC0000X
TXP5549207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease