Provider Demographics
NPI:1306812755
Name:ODIOT, ERIC FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:FERNANDO
Last Name:ODIOT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:576 CALLE CESAR GONZALEZ
Mailing Address - Street 2:DORAL BANK CENTER SUITE 204
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3756
Mailing Address - Country:US
Mailing Address - Phone:787-294-1919
Mailing Address - Fax:787-294-1921
Practice Address - Street 1:576 CALLE CESAR GONZALEZ
Practice Address - Street 2:DORAL BANK CENTER SUITE 204
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3756
Practice Address - Country:US
Practice Address - Phone:787-294-1919
Practice Address - Fax:787-294-1921
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR009283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF01062Medicare UPIN
PR0082564Medicare ID - Type Unspecified