Healthcare Provider Details

I. General information

NPI: 1164535191
Provider Name (Legal Business Name): JORGE MUNOZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 AVENUE E
HONDO TX
78861-3525
US

IV. Provider business mailing address

3100 AVENUE E
HONDO TX
78861-3534
US

V. Phone/Fax

Practice location:
  • Phone: 830-426-7444
  • Fax: 830-426-7471
Mailing address:
  • Phone: 830-426-7444
  • Fax: 830-426-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ7596
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: