Provider Demographics
NPI:1649385030
Name:RIVERA-PABON, GERARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:RIVERA-PABON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MANSIONES DEL SUR
Mailing Address - Street 2:46 CALLE VIGIA
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2084
Mailing Address - Country:US
Mailing Address - Phone:787-840-4898
Mailing Address - Fax:787-840-4898
Practice Address - Street 1:CALLE UNION
Practice Address - Street 2:NUM 109
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-840-4898
Practice Address - Fax:787-840-4898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12003208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12003OtherLICENSE
PRG78952Medicare UPIN