Provider Demographics
NPI:1437135589
Name:SUAREZ- IRIZARRY, IVAN N (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:N
Last Name:SUAREZ- IRIZARRY
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:PO BOX 6409
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6409
Mailing Address - Country:US
Mailing Address - Phone:787-818-6010
Mailing Address - Fax:787-818-6010
Practice Address - Street 1:550 CONCEPCION VERA AYALA
Practice Address - Street 2:CARRETERA 110 KM.12.2
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10445207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88079Medicare ID - Type UnspecifiedPROVIDER
PRG41173Medicare UPIN