=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538445036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JORGE A. ARZAC M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2011
-----------------------------------------------------
Last Update Date | 06/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 W COLORADO BLVD STE 728
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75208-2357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-941-0100
-----------------------------------------------------
Fax | 214-941-7024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 W COLORADO BLVD STE 728
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75208-2357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-941-0100
-----------------------------------------------------
Fax | 214-941-7024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JORGE ARTURO ARZAC
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-941-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | J9954
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------