Provider Demographics
NPI:1639167729
Name:GONZALEZ OLIVIERI, RADAMES SR (MD)
Entity Type:Individual
Prefix:DR
First Name:RADAMES
Middle Name:
Last Name:GONZALEZ OLIVIERI
Suffix:SR
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 1:2225 PONCE BY PASS
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1368
Mailing Address - Country:US
Mailing Address - Phone:787-843-9110
Mailing Address - Fax:787-259-2195
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:SUITE 501
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1368
Practice Address - Country:US
Practice Address - Phone:787-843-9110
Practice Address - Fax:787-259-2195
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8434208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7310063OtherHUMANA
PR7310063OtherHUMANA
PRE20940Medicare UPIN