Provider Demographics
NPI:1164567954
Name:GIL ESCUDERO, ALCIDES (MD)
Entity Type:Individual
Prefix:
First Name:ALCIDES
Middle Name:
Last Name:GIL ESCUDERO
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 1:28 ACEROLA ST MILAVILLE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5105
Mailing Address - Country:US
Mailing Address - Phone:787-789-7823
Mailing Address - Fax:787-708-9026
Practice Address - Street 1:68 SANTA CRUZ AVENUE
Practice Address - Street 2:TORRE SAN PABLO SUITE 701
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-4527
Practice Address - Fax:787-790-4580
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3889207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
95179Medicare ID - Type Unspecified
C78111Medicare UPIN