Provider Demographics
NPI:1104849686
Name:PAGAN, LUIS RAIMUNDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAIMUNDO
Last Name:PAGAN
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 1:7100 W 20TH AVE
Mailing Address - Street 2:SUITE G-176
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1897
Mailing Address - Country:US
Mailing Address - Phone:305-826-3366
Mailing Address - Fax:305-826-7973
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE G-176
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-826-3366
Practice Address - Fax:305-826-7973
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00033362207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042852300Medicaid
FL042852300Medicaid
FLD64017Medicare UPIN