Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 16996 | PR |
NPI | 1093912198 |
---|---|
Provider Name | Jose L. Perez Maldonado |
First Address | San Juan, PR 00936-7488 |
Second Address | San Juan, PR 00918-3756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 30/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8AD833 | BCBS (01) | TX |