Provider Demographics
NPI:1740782788
Name:LDG MEDICAL SERVICES GROUP, LLC
Entity Type:Organization
Organization Name:LDG MEDICAL SERVICES GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DE GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-479-6620
Mailing Address - Street 1:1225 PONCE DE LEON AVE
Mailing Address - Street 2:VIG TOWER SUITE 702
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3108
Mailing Address - Country:US
Mailing Address - Phone:787-479-6620
Mailing Address - Fax:877-777-3208
Practice Address - Street 1:1225 PONCE DE LEON
Practice Address - Street 2:VIG TOWER SUITE 702
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1903
Practice Address - Country:US
Practice Address - Phone:787-721-0279
Practice Address - Fax:877-777-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty