Provider Demographics
NPI:1427049378
Name:GUZMAN, JORGE G (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:G
Last Name:GUZMAN
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 1:4815 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2705
Mailing Address - Country:US
Mailing Address - Phone:915-521-7415
Mailing Address - Fax:915-521-7920
Practice Address - Street 1:1485 GEORGE DIETER
Practice Address - Street 2:SUITE 107
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-521-2259
Practice Address - Fax:915-521-7082
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106138402Medicaid
TX106138402Medicaid
TX89466NMedicare ID - Type UnspecifiedMEDICARE ID