Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 00913 | PR |
NPI | 1134120314 |
---|---|
Provider Name | Edgar Echevarria-Stuart |
First Address | San Juan, PR 00929-0736 |
Second Address | San Juan, PR 00923-3337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4-1164 | TRIPLE-S, INC. (01) | PR |