Provider Demographics
NPI:1417965179
Name:JORGE L RINCON MD FACS PA
Entity type:Organization
Organization Name:JORGE L RINCON MD FACS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RINCON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-587-7744
Mailing Address - Street 1:PO BOX 792424
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78279-2424
Mailing Address - Country:US
Mailing Address - Phone:210-683-8776
Mailing Address - Fax:210-745-0990
Practice Address - Street 1:1162 E SONTERRA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4049
Practice Address - Country:US
Practice Address - Phone:210-587-7744
Practice Address - Fax:210-745-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179313501Medicaid
TX0085NROtherBCBS GROUP
TXL8172OtherSTATE LICENSE
TX051736OtherECFMG NUMBER
1356303960OtherNPI INDIVIDUAL NUMBER
TX8V9840OtherBCBS INVIDUAL
TX179314301Medicaid
TX179314301Medicaid
TXL8172OtherSTATE LICENSE
1356303960OtherNPI INDIVIDUAL NUMBER