Healthcare Provider Details

I. General information

NPI: 1205856382
Provider Name (Legal Business Name): JORGE ARZOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORGE ARZOLA MARRERO M.D.

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11141 PARKVIEW PLAZA DR STE 320
FORT WAYNE IN
46845-1714
US

IV. Provider business mailing address

3737 SOUTHERN BLVD STE 4200
KETTERING OH
45429-0135
US

V. Phone/Fax

Practice location:
  • Phone: 260-425-5400
  • Fax:
Mailing address:
  • Phone: 937-294-1489
  • Fax: 937-297-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number01053421A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35121647
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01053421A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: