Provider Demographics
NPI:1023508389
Name:LUEGE HERMOSILLA, JORGE CARLOS (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:CARLOS
Last Name:LUEGE HERMOSILLA
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 1:8325 NW EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-6006
Mailing Address - Country:US
Mailing Address - Phone:405-728-8000
Mailing Address - Fax:
Practice Address - Street 1:8325 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6006
Practice Address - Country:US
Practice Address - Phone:405-728-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine