Provider Demographics
NPI:1033175856
Name:FUMERO, JOSE ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ROBERTO
Last Name:FUMERO
Suffix:
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 19297
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910
Mailing Address - Country:US
Mailing Address - Phone:787-725-3555
Mailing Address - Fax:781-723-6866
Practice Address - Street 1:AVE PONCE DE LEON #1507
Practice Address - Street 2:SUITE 1-C PDA 22
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-725-3555
Practice Address - Fax:787-723-6866
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8068207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0082159Medicare ID - Type Unspecified
E61497Medicare UPIN