Provider Demographics
NPI:1699814053
Name:CONTRERAS, JORGE MARIO (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:MARIO
Last Name:CONTRERAS
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 1:3800 HOUMA BVD
Mailing Address - Street 2:STE 250
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-885-3272
Mailing Address - Fax:504-456-6600
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:STE 250
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-885-3272
Practice Address - Fax:504-456-6600
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1496430Medicaid
LA5H3175CE35Medicare PIN
H17463Medicare UPIN