Provider Demographics
NPI:1427182773
Name:CARRERA, JORGE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:D
Last Name:CARRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:DAMIAN
Other - Last Name:CARRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6TH STREET, K-58
Mailing Address - Street 2:URB. PRADO ALTO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-834-4770
Mailing Address - Fax:787-265-2120
Practice Address - Street 1:6TH STREET, K-58
Practice Address - Street 2:URB. PRADO ALTO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-834-4770
Practice Address - Fax:787-265-2120
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7777174400000X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE43322Medicare UPIN
PR99590Medicare ID - Type Unspecified
PR009-9590Medicare PIN