Provider Demographics
NPI:1811191182
Name:AMADOR, JUAN F (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:F
Last Name:AMADOR
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:G31 PASEO SAN JUAN
Mailing Address - Street 2:ADOQUINES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-312-5706
Mailing Address - Fax:
Practice Address - Street 1:COND SAN JUAN # G31
Practice Address - Street 2:ADOQUINES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3812
Practice Address - Country:US
Practice Address - Phone:787-312-5706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4368902085R0202X
PR16413208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102298180-0001Medicaid
PA153113D2YMedicare PIN