Provider Demographics
NPI:1003855123
Name:NEGRON, JORGE ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALBERTO
Last Name:NEGRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:ALBERTO
Other - Last Name:NEGRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19646
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1646
Mailing Address - Country:US
Mailing Address - Phone:787-721-5677
Mailing Address - Fax:
Practice Address - Street 1:650 CALLE LLOVERAS STE 203
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2114
Practice Address - Country:US
Practice Address - Phone:787-721-5677
Practice Address - Fax:787-721-5588
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6235207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD26651Medicare UPIN