Provider Demographics
NPI:1841297421
Name:SIFUENTES, JORGE A JR (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:SIFUENTES
Suffix:JR
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 1:713 N. DEAHL
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007
Mailing Address - Country:US
Mailing Address - Phone:806-274-7057
Mailing Address - Fax:806-274-2531
Practice Address - Street 1:713 DEAHL ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-3522
Practice Address - Country:US
Practice Address - Phone:806-274-7057
Practice Address - Fax:806-274-2531
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11522380OtherCAQH
TX7162687OtherAETNA
TX8S2900OtherBLUE CROSS BLUE SHIELD
TX178065201Medicaid
TX45D1041283OtherCLIA