Provider Demographics
NPI:1134125925
Name:RODRIGUEZ-SURO, AGUSTIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:J
Last Name:RODRIGUEZ-SURO
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 19206
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1206
Mailing Address - Country:US
Mailing Address - Phone:787-579-5829
Mailing Address - Fax:787-281-7615
Practice Address - Street 1:1056 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 610 FIRST BANK BLDG.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5015
Practice Address - Country:US
Practice Address - Phone:787-772-4669
Practice Address - Fax:787-281-7615
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-26
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95202Medicare UPIN
PR20275Medicare ID - Type Unspecified