Provider Demographics
NPI:1235230277
Name:TALAVERA, TOMAS JESUS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:JESUS
Last Name:TALAVERA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:HC04 BOX 48700
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9716
Mailing Address - Country:US
Mailing Address - Phone:787-262-3506
Mailing Address - Fax:787-881-9402
Practice Address - Street 1:CARR 129 AVE SAN LUIS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-9402
Practice Address - Fax:787-881-9402
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F18915Medicare UPIN
82660Medicare ID - Type Unspecified