Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 10579 | PR |
NPI | 1720159965 |
---|---|
Provider Name | Dr. Carlos J Fraga |
First Address | Bayamon, PR 00961-7019 |
Second Address | Bayamon, PR 00961-7019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F54668 | (02) | PR |