Provider Demographics
NPI:1184732919
Name:VILLAFUERTE VALLEJOS, JORGE ARTURO (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ARTURO
Last Name:VILLAFUERTE VALLEJOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:A
Other - Last Name:VILLAFUERTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3806 STEARNS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-7118
Mailing Address - Country:US
Mailing Address - Phone:781-652-1530
Mailing Address - Fax:
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:617-232-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226375207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226375OtherFULL MEDICAL LICENSE