| Doctor Name: | DR. JORGE EDUARDO MASSARE-RODRIGUEZ |
| NPI Number: | 1093973661 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | M7577 |
| Business Practice Address: | 709 Hollybrook Dr Suite 2301 Longview, TX - 756052411 |
| Business Phone Number: | 9037575804 |
| Business Fax Number: | 9032322888 |
| Mailing Address: | Po Box 847176, DALLAS |
| State: | TX |
| Postal Code: | 752847176 |
| Phone Number: | 9032371800 |
| Fax Number: | 9032371810 |
| NPI Enumeration Date: | 05/29/2008 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | M7577 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |