Provider Demographics
NPI:1063474872
Name:MARTINEZ-SOUSS, JAIME (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:MARTINEZ-SOUSS
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 363532
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3532
Mailing Address - Country:US
Mailing Address - Phone:787-723-9025
Mailing Address - Fax:787-722-1987
Practice Address - Street 1:328 DE DIEGO AVE
Practice Address - Street 2:SUITE 202 PONCE DE LEON AVE.
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1706
Practice Address - Country:US
Practice Address - Phone:787-723-9025
Practice Address - Fax:787-722-1987
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8869207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-92206Medicare UPIN
PR82391Medicare ID - Type Unspecified