Provider Demographics
NPI:1033101068
Name:MARQUES BIBILONI, JOSE A SR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:MARQUES BIBILONI
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19798
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1798
Mailing Address - Country:US
Mailing Address - Phone:787-728-2479
Mailing Address - Fax:787-726-7447
Practice Address - Street 1:MANUEL PAVIA FERNANDEZ 655 4TH PISO
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-728-2479
Practice Address - Fax:787-786-7447
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10042207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40291Medicare UPIN
PR84262Medicare ID - Type Unspecified