Provider Demographics
NPI:1710458674
Name:DE JESUS, FERMIN L (MD)
Entity Type:Individual
Prefix:
First Name:FERMIN
Middle Name:L
Last Name:DE JESUS
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:HC 1 BOX 6076
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-9607
Mailing Address - Country:US
Mailing Address - Phone:787-354-2907
Mailing Address - Fax:
Practice Address - Street 1:CARR 753 KM 6.4
Practice Address - Street 2:BO YAUREL SECTOR PALMAREJO
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:787-354-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21180208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice