Provider Demographics
NPI:1407851306
Name:AMADOR, PEDRO JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JUAN
Last Name:AMADOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CONCORDIA 8118 SUITE 210
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2027
Mailing Address - Country:US
Mailing Address - Phone:787-841-4684
Mailing Address - Fax:787-984-1231
Practice Address - Street 1:CONCORDIA 8118 SUITE 210
Practice Address - Street 2:GALERIA PROFESIONAL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2027
Practice Address - Country:US
Practice Address - Phone:787-841-4684
Practice Address - Fax:787-984-1231
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR13820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH48952Medicare UPIN