Provider Demographics
NPI:1164463485
Name:GAONA, JAIME EDGAR (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:EDGAR
Last Name:GAONA
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:URBANIZACION ESTANCIAS DEL GOLF 654
Mailing Address - Street 2:LUIS MORALES
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-284-8926
Mailing Address - Fax:787-284-8926
Practice Address - Street 1:CDT JAYUYA CALLE CEMENTERIO 2
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-828-3290
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14890208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09188Medicare UPIN
0022318Medicare ID - Type Unspecified