Provider Demographics
NPI:1225178874
Name:PEREA, RAMON M (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:M
Last Name:PEREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 444
Mailing Address - Street 2:PO BOX 70344
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-765-2312
Mailing Address - Fax:787-759-8159
Practice Address - Street 1:369 CALLE DE DIEGO
Practice Address - Street 2:SUITE 510
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-759-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11289207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF86958Medicare UPIN
PR0089011Medicare ID - Type UnspecifiedPHYSICIAN