Provider Demographics
NPI:1770653594
Name:CAUSSADE, GERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GERRY
Middle Name:
Last Name:CAUSSADE
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:PG63 PLAZA ISLENA
Mailing Address - Street 2:URB. PACIFICA ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6152
Mailing Address - Country:US
Mailing Address - Phone:787-637-5585
Mailing Address - Fax:
Practice Address - Street 1:1107 CALLE WILLIAM JONES
Practice Address - Street 2:ALTOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3441
Practice Address - Country:US
Practice Address - Phone:787-764-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81690Medicare ID - Type Unspecified
PRE63391Medicare UPIN