Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 005613 | PR |
N | 207RG0100X | Gastroenterologist | 5613 | PR |
NPI | 1023095692 |
---|---|
Provider Name | Dr. Carlos Micames Muzaber |
First Address | Mayaguez, PR 00681-1092 |
Second Address | Mayaguez, PR 00680-0111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 08/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E-20115 | (02) | PR |