Provider Demographics
NPI:1679774830
Name:MAYSONET, JOSE I (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:I
Last Name:MAYSONET
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:PG121 VIA ARCOIRIS
Mailing Address - Street 2:URB PACIFICA ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6154
Mailing Address - Country:US
Mailing Address - Phone:787-474-7346
Mailing Address - Fax:
Practice Address - Street 1:PG121 VIA ARCOIRIS
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6154
Practice Address - Country:US
Practice Address - Phone:787-474-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10294208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82917Medicare ID - Type Unspecified