Provider Demographics
NPI:1649757634
Name:PAGAN, WENDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDEL
Middle Name:
Last Name:PAGAN
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 1:63 CALLE VIRGINIA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-3820
Mailing Address - Country:US
Mailing Address - Phone:787-907-3891
Mailing Address - Fax:
Practice Address - Street 1:I7 CALLE JULIA DE BURGOS
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3351
Practice Address - Country:US
Practice Address - Phone:787-907-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021047208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRJM264Medicaid