Provider Demographics
NPI:1184656423
Name:LEBRON RODRIGUEZ, ANGEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:R
Last Name:LEBRON RODRIGUEZ
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 801208
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1208
Mailing Address - Country:US
Mailing Address - Phone:787-236-8282
Mailing Address - Fax:787-813-1836
Practice Address - Street 1:TERRA SENORIAL CALLE 3 NUM 60
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3311
Practice Address - Country:US
Practice Address - Phone:787-236-8282
Practice Address - Fax:787-813-1836
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16198OtherMEDICAL LICENSE
PRI59721Medicare UPIN
PR24715Medicare ID - Type Unspecified