Provider Demographics
NPI:1295384295
Name:CHEVERE, SERGIO ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:ALEJANDRO
Last Name:CHEVERE
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:URB EL MONTE 3166 MARBELLA STREET
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-458-5320
Mailing Address - Fax:
Practice Address - Street 1:CALLE FERROCARRIL 607 ESQUINA CALLE TORRRES
Practice Address - Street 2:EDIFICIO SAN FRANCISCO OFICINA 201
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-844-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22-140208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22-140OtherPUERTO RICO MEDICAL DISCIPLINE AND LICENSURE BOARD