Provider Demographics
NPI:1114994282
Name:BALLESTER ECHEGARAY, JOSE JAIME (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:JAIME
Last Name:BALLESTER ECHEGARAY
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0749
Mailing Address - Country:US
Mailing Address - Phone:787-804-0010
Mailing Address - Fax:787-804-0110
Practice Address - Street 1:PLZ YAGUEZ
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3874
Practice Address - Country:US
Practice Address - Phone:787-805-7550
Practice Address - Fax:787-805-7570
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9658173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF49311Medicare UPIN