Provider Demographics
NPI:1619962446
Name:FUENTES, JOSE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:FUENTES
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1000 CARR 831 APT 2031
Mailing Address - Street 2:COND LA FLORESTA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9558
Mailing Address - Country:US
Mailing Address - Phone:787-529-5545
Mailing Address - Fax:787-250-8597
Practice Address - Street 1:1000 CARR 831 APT 2031
Practice Address - Street 2:COND LA FLORESTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9558
Practice Address - Country:US
Practice Address - Phone:787-529-5545
Practice Address - Fax:787-250-8597
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6899207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79754Medicare UPIN
PR0028523Medicare PIN