=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154307411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORGE EDMUND TIJMES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2005
-----------------------------------------------------
Last Update Date | 09/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 N MCCOLL RD SUITE A
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-9348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-687-2032
-----------------------------------------------------
Fax | 956-668-8939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20474
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-4099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-687-2032
-----------------------------------------------------
Fax | 956-668-8939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | E3784
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------