Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 4763 | PR |
NPI | 1093819112 |
---|---|
Provider Name | Mr. Jan Pierre Zegarra |
First Address | San Juan, PR 00927-5832 |
Second Address | San Juan, PR 00927-5832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067741 | CRUZ AZUL (01) | |
1700109 | HUMANA HEALTH (01) | |
25716 | TS (01) | |
E30422 | (02) |