=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417965179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JORGE L RINCON MD FACS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 03/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1162 E SONTERRA BLVD STE 210
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-4049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-587-7744
-----------------------------------------------------
Fax | 210-745-0990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 792424
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78279-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-683-8776
-----------------------------------------------------
Fax | 210-745-0990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JORGE L RINCON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-587-7744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | L8172
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------