Provider Demographics
NPI:1023025285
Name:CHEVERE, CARLOS M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
Last Name:CHEVERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PMB 10 PO BOX 70344
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-754-0315
Mailing Address - Fax:787-763-9871
Practice Address - Street 1:ISAAC GONZALEZ MARTINEZ HOSPITAL CENTRO MEDICO AREA
Practice Address - Street 2:RADIOTERAPIA BASEMENT
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-754-0315
Practice Address - Fax:787-763-9871
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR106702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83429Medicare ID - Type Unspecified
PRF63413Medicare UPIN