Granadillo De Luque, Jorge

Granadillo De Luque, Jorge is an individual health care provider with primary practice located at 1 Childrens Pl Div Ped Genetics And Genomic Med, Saint Louis MO 63110-1002. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.). Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.) is his primary health care specialty. Granadillo De Luque, Jorge can be contacted via phone (314) 454-6093.

Contact Information

Primary practice address
1 Childrens Pl Div Ped Genetics And Genomic Med Saint Louis MO 63110-1002
Phone: (314) 454-6093
Fax: (844) 965-9624
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2017041051 Missouri
Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.) 207SG0201X 2017041051 Missouri

Profile Details

NPI number 1952717902
LBN Legal business name Granadillo De Luque, Jorge
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 9th, 2014
Last updated May 9th, 2024 - about 7 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952717902 NPPES
Missouri MEDICAID 200054630

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