Healthcare Provider Details

I. General information

NPI: 1134154172
Provider Name (Legal Business Name): JORGE CARLOS MAGALLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CAMDEN ST STE 102
SAN ANTONIO TX
78215-2012
US

IV. Provider business mailing address

12446 WEST AVE STE 200
SAN ANTONIO TX
78216-2517
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-9800
  • Fax:
Mailing address:
  • Phone: 210-525-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number226745
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number244808
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberP5549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: