Provider Demographics
NPI:1205832144
Name:ACARON SOUFFRONT, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:ACARON SOUFFRONT
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 362025
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2025
Mailing Address - Country:US
Mailing Address - Phone:787-758-1243
Mailing Address - Fax:787-758-0975
Practice Address - Street 1:716 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4503
Practice Address - Country:US
Practice Address - Phone:787-758-7500
Practice Address - Fax:787-758-0975
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2908208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE00127Medicare UPIN
PR0023706Medicare ID - Type Unspecified
0028100CMedicare PIN