Provider Demographics
NPI:1790991495
Name:PURCELL-JORDAN, RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:PURCELL-JORDAN
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:URB. LADERAS DE SAN JUAN
Mailing Address - Street 2:44 CALLE SAUCO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9318
Mailing Address - Country:US
Mailing Address - Phone:787-625-9425
Mailing Address - Fax:
Practice Address - Street 1:URB. LADERAS DE SAN JUAN
Practice Address - Street 2:44 CALLE SAUCO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9318
Practice Address - Country:US
Practice Address - Phone:787-625-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13138207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH75744Medicare ID - Type Unspecified