Provider Demographics
NPI:1083610828
Name:REYMUNDE POSSO, ALVARO (MD,FACP,FACG,AGAF)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:
Last Name:REYMUNDE POSSO
Suffix:
Gender:M
Credentials:MD,FACP,FACG,AGAF
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 334069
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-4069
Mailing Address - Country:US
Mailing Address - Phone:787-259-8212
Mailing Address - Fax:787-848-7979
Practice Address - Street 1:EDIF PARRA STE 806
Practice Address - Street 2:2225 PONCE BY PASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-259-8212
Practice Address - Fax:787-848-7979
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-01-21
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
PR207RG0100X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7737OtherLICENCE MEDICAL
PR207RG0100XOtherINTERNAL MEDICINE:GASTROE
PR82468Medicare ID - Type UnspecifiedPROVIDER NUMBER IN MEDICA
PRE90880Medicare UPIN