Provider Demographics
NPI:1710937891
Name:NEVAREZ-SOSTRE, EDGAR A (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:A
Last Name:NEVAREZ-SOSTRE
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:CALLE 9 # B-4 URB. JARDINES DE DORADO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-240-1809
Mailing Address - Fax:787-796-7313
Practice Address - Street 1:CARRETERA #2 KM. 4 HCT. 40
Practice Address - Street 2:EDIFICIO 4060 SUITE # 6
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-240-1809
Practice Address - Fax:787-796-7313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6740055OtherPHYSICIAN
PR990472OtherPHYSICIAN
PR2-12124OtherPHYSICIAN
PR5089OtherPHYSICIAN
PRX0000OtherPHYSICIAN
PR990472OtherPHYSICIAN
PR89612Medicare ID - Type UnspecifiedPHYSICIAN