Provider Demographics
NPI:1518943109
Name:BOU-UMPIERRE, JENARO RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:JENARO
Middle Name:RAMON
Last Name:BOU-UMPIERRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:CALLE BOU 57 INT
Mailing Address - Street 2:
Mailing Address - City:COROZOL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-859-1545
Mailing Address - Fax:787-859-1545
Practice Address - Street 1:CALLE BOU 57 INT
Practice Address - Street 2:
Practice Address - City:COROZOL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-1545
Practice Address - Fax:787-859-1545
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
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1296835PEOtherAMERICAN HEALTH INSURANCE
CT26835OtherLIFE INSURANCE CO
068391OtherLA CRUZ AZUL DE PR
PR6460017OtherHUMANA HEALTH INSURANCE
41745OtherPROSSAM