Provider Demographics
NPI:1831158427
Name:PATINO, JORGE A (MD, PA)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:PATINO
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 PAREDES LINE RD
Mailing Address - Street 2:SUITE 198
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9740
Mailing Address - Country:US
Mailing Address - Phone:956-542-3200
Mailing Address - Fax:956-504-6733
Practice Address - Street 1:5460 PAREDES LINE RD
Practice Address - Street 2:SUITE 198
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-9740
Practice Address - Country:US
Practice Address - Phone:956-542-3200
Practice Address - Fax:956-504-6733
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6684208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092281703Medicaid
TX092281705Medicaid
TX092281704Medicaid
TX092281708Medicaid
TX092281707Medicaid
TX092281703Medicaid