Provider Demographics
NPI:1093997793
Name:BIDOT, MAYRA D (MD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:D
Last Name:BIDOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CALLE R MARTINEZ NADAL S
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4927
Mailing Address - Country:US
Mailing Address - Phone:787-265-4610
Mailing Address - Fax:787-255-9400
Practice Address - Street 1:14 CALLE R MARTINEZ NADAL S
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4927
Practice Address - Country:US
Practice Address - Phone:787-265-4610
Practice Address - Fax:787-265-4610
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9542208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE63416Medicare UPIN