Provider Demographics
NPI:1366490526
Name:PURAS BAEZ, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:PURAS BAEZ
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 1:1431 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-4026
Mailing Address - Country:US
Mailing Address - Phone:787-977-1770
Mailing Address - Fax:787-977-1774
Practice Address - Street 1:1431 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 601
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4026
Practice Address - Country:US
Practice Address - Phone:787-977-1770
Practice Address - Fax:787-977-1774
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25230Medicaid
PR25230Medicaid