Provider Demographics
NPI:1063449379
Name:ENCARNACION CONCEPCION, EDUARDO E
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:E
Last Name:ENCARNACION CONCEPCION
Suffix:
Gender:M
Credentials:
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 1537
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1537
Mailing Address - Country:US
Mailing Address - Phone:787-280-1335
Mailing Address - Fax:787-280-1335
Practice Address - Street 1:126 CALLE PAVIA FERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-1537
Practice Address - Country:US
Practice Address - Phone:787-280-1335
Practice Address - Fax:787-280-1335
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15210208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79165Medicare UPIN