Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 13752 | PR |
NPI | 1023190071 |
---|---|
Provider Name | Dr. Jephte Rodriguez Martinez |
First Address | Mayaguez, PR 00680-4866 |
Second Address | Mayaguez, PR 00680-4866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I-51143 | (02) | PR |