Provider Demographics
NPI:1467548370
Name:PEREZ BAILON, ESTEBAN RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:RAMON
Last Name:PEREZ BAILON
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 133
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703
Mailing Address - Country:US
Mailing Address - Phone:787-732-2747
Mailing Address - Fax:
Practice Address - Street 1:CARR 156 KM 49.4
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-633-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13662208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0020510Medicare ID - Type Unspecified
H35863Medicare UPIN