| Doctor Name: | JORGE M MEDINA |
| NPI Number: | 1477520930 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 205001 |
| Business Practice Address: | 222 15th Ave Se Puyallup, WA - 983723754 |
| Business Phone Number: | 2538414353 |
| Business Fax Number: | 2535815698 |
| Mailing Address: | 7424 Bridgeport Way W, Suite 103 LAKEWOOD |
| State: | WA |
| Postal Code: | 984998120 |
| Phone Number: | 2538414353 |
| Fax Number: | 2535815698 |
| NPI Enumeration Date: | 03/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 205001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |