Provider Demographics
NPI:1700847654
Name:LIBOY, IVAN ALCARAZ (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:ALCARAZ
Last Name:LIBOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IVAN
Other - Middle Name:A
Other - Last Name:LIBOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10431
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0431
Mailing Address - Country:US
Mailing Address - Phone:787-781-2565
Mailing Address - Fax:787-782-9524
Practice Address - Street 1:AVE JESUS T PINERO 1250 CAPARRA TERRACE
Practice Address - Street 2:CENTRO OFTALNCOLOGICO METROPOLITANO CSP
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-781-2565
Practice Address - Fax:787-781-2565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3891207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08202Medicare UPIN
PR24161EMedicare ID - Type Unspecified