Provider Demographics
NPI:1073585360
Name:FREESE-SUAREZ, JOSE R (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:FREESE-SUAREZ
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 1:2 CALLE MADRID
Mailing Address - Street 2:COND PALMA REAL APT 14F
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2429
Mailing Address - Country:US
Mailing Address - Phone:787-723-1093
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:TORRE AUXILIO MUTUO SUITE 403
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-766-4415
Practice Address - Fax:787-294-1041
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6429207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
97819Medicare ID - Type Unspecified
C84171Medicare UPIN