Provider Demographics
NPI:1497968143
Name:AMADOR-CHACON, NESTOR E (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:E
Last Name:AMADOR-CHACON
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 1144
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1144
Mailing Address - Country:US
Mailing Address - Phone:787-244-8136
Mailing Address - Fax:
Practice Address - Street 1:URB FLAMBOYAN
Practice Address - Street 2:MARGINAL SUR B-11
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-1144
Practice Address - Country:US
Practice Address - Phone:787-854-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13100207QA0505X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine