Provider Demographics
NPI:1508949637
Name:PAGAN ROMERO, ANIBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIBAL
Middle Name:
Last Name:PAGAN ROMERO
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 1275
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1275
Mailing Address - Country:US
Mailing Address - Phone:939-649-1089
Mailing Address - Fax:
Practice Address - Street 1:CARR NUM 2 KM 101.6
Practice Address - Street 2:BO TERRANOVA MARGINAL DEL PARQUE
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-0000
Practice Address - Country:US
Practice Address - Phone:787-895-0914
Practice Address - Fax:787-895-6945
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11789208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087764Medicare UPIN