Provider Demographics
NPI:1881620284
Name:TAPIA, JORGE ISAAC (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ISAAC
Last Name:TAPIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 SHREVEPORT HWY
Mailing Address - Street 2:#226
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-2006
Mailing Address - Country:US
Mailing Address - Phone:318-473-2101
Mailing Address - Fax:
Practice Address - Street 1:2114 SHREVEPORT HWY
Practice Address - Street 2:#226
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-2006
Practice Address - Country:US
Practice Address - Phone:318-473-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06923R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1436947Medicaid
LA1436947Medicaid
LAH25174Medicare UPIN