Provider Demographics
NPI:1649901133
Name:JORGE L. ELLER, MD INC
Entity type:Organization
Organization Name:JORGE L. ELLER, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-348-0706
Mailing Address - Street 1:72780 COUNTRY CLUB DR STE 104
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4150
Mailing Address - Country:US
Mailing Address - Phone:760-837-8020
Mailing Address - Fax:760-834-3780
Practice Address - Street 1:72780 COUNTRY CLUB DR STE 104
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4150
Practice Address - Country:US
Practice Address - Phone:760-837-8020
Practice Address - Fax:760-834-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty