Provider Demographics
NPI:1629274162
Name:MATOS POSTIGO, EDUARDO SR (MD LICENSE 11827)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:MATOS POSTIGO
Suffix:SR
Gender:M
Credentials:MD LICENSE 11827
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 JUSTO MARTINEZ ST
Mailing Address - Street 2:URB PERLA DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0321
Mailing Address - Country:US
Mailing Address - Phone:787-841-0901
Mailing Address - Fax:
Practice Address - Street 1:AVE SANTIAGO DE LOS CABALLEROS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-848-4545
Practice Address - Fax:787-259-8659
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11827208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56713Medicare ID - Type Unspecified