Provider Demographics
NPI:1558348243
Name:ENCARNACION, GASPAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GASPAR
Middle Name:
Last Name:ENCARNACION
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 1:512 JUAN J JIMENEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2605
Mailing Address - Country:US
Mailing Address - Phone:787-764-4536
Mailing Address - Fax:787-754-8322
Practice Address - Street 1:512 JUAN J JIMENEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2605
Practice Address - Country:US
Practice Address - Phone:787-764-4536
Practice Address - Fax:787-754-8322
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1686208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020290Medicare ID - Type Unspecified
C79137Medicare UPIN