Provider Demographics
NPI:1104816404
Name:CORONA, JORGE (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:CORONA
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 1:8230 WALNUT HILL LN
Mailing Address - Street 2:SUITE 508
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4482
Mailing Address - Country:US
Mailing Address - Phone:214-369-0555
Mailing Address - Fax:214-363-6759
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:SUITE 508
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:214-369-0555
Practice Address - Fax:214-363-6759
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5109207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166446803Medicaid
TX166446803Medicaid
TX8F20647Medicare PIN
TX8K1358Medicare PIN
TXI05061Medicare UPIN
TXP00720109Medicare PIN
TXP00715163Medicare PIN
TX613596Medicare PIN