Provider Demographics
NPI:1083829329
Name:ETIENNE, RUFUS (MD)
Entity Type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RUFUS
Other - Middle Name:
Other - Last Name:ETIENNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0305
Mailing Address - Country:US
Mailing Address - Phone:787-525-1713
Mailing Address - Fax:
Practice Address - Street 1:997 K1.0 ST. BO. DESTINO
Practice Address - Street 2:
Practice Address - City:VIEQUES
Practice Address - State:PR
Practice Address - Zip Code:00765
Practice Address - Country:US
Practice Address - Phone:787-741-0392
Practice Address - Fax:787-741-2550
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7522207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology