Provider Demographics
NPI:1568409894
Name:LODEIRO, JORGE GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:GABRIEL
Last Name:LODEIRO
Suffix:
Gender:
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:859-263-8669
Practice Address - Street 1:170 N EAGLE CREEK DR STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9087
Practice Address - Country:US
Practice Address - Phone:859-263-0141
Practice Address - Fax:859-263-8669
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0085207VM0101X
TN40772207VM0101X
KY60362207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21422Medicare UPIN
TN103I162833Medicare PIN
TN3818879Medicare PIN