Provider Demographics
NPI:1508855644
Name:ALAYON ANTA, GERARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:ALAYON ANTA
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 330782
Mailing Address - Street 2:ATOCHA STATION
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-0782
Mailing Address - Country:US
Mailing Address - Phone:787-844-3153
Mailing Address - Fax:787-840-1964
Practice Address - Street 1:2520 AVE OBISPADO
Practice Address - Street 2:URB. ALHAMBRA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3841
Practice Address - Country:US
Practice Address - Phone:787-844-3153
Practice Address - Fax:787-840-1964
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9075207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82952Medicare ID - Type Unspecified
PRF30535Medicare UPIN