1619763174 NPI number — DR. JORGE ADALBERTO AMADOR JR. MD

Table of content: DR. JORGE ADALBERTO AMADOR JR. MD (NPI 1619763174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619763174 NPI number — DR. JORGE ADALBERTO AMADOR JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMADOR
Provider First Name:
JORGE
Provider Middle Name:
ADALBERTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619763174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 S COULTER ST STE 1500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106-1786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-414-9800
Provider Business Mailing Address Fax Number:
806-354-5689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4265 58TH AVE APT 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLADENSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20710-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-859-0947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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