Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 022129 | PR |
NPI | 1013503309 |
---|---|
Provider Name | Dr. Jose Luis Lebron |
First Address | Guayama, PR 00784 |
Second Address | Guayama, PR 00784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2020 |
Last Update Date | 21/12/2020 |