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General NPI Number Information
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NPI Number | 1457420515
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Entity Type | Organization
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Legal Business Name | JORGE R BROTHERS M D P A
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 418 N UTICA AVE
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City | LUBBOCK
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State | TX
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Zip | 79416-3035
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Country | US
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Telephone | 806-771-5882
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Fax | 806-687-9002
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Provider Business Mailing Address
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Address Line | 418 N UTICA AVE
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City | LUBBOCK
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State | TX
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Zip | 79416-3035
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Country | US
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Telephone | 806-771-5882
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Fax | 806-687-9002
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Authorized Official
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Title or Position | OWNER
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Name | JORGE R BROTHERS
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Credential | M.D.
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Telephone | 806-771-5882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H1048
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License Number State | TX
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