Provider Demographics
NPI:1821061383
Name:DE JESUS, JOEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:J
Last Name:DE JESUS
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:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0510
Mailing Address - Country:US
Mailing Address - Phone:787-579-2291
Mailing Address - Fax:
Practice Address - Street 1:MARGINAL AVE. PEDRO ALBIZU CAMPOS
Practice Address - Street 2:222 URB VIVES CALLE 4
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-4005
Practice Address - Fax:787-866-4072
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14017207RG0100X, 193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No193400000XGroupSingle Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037486102Medicaid
PR14017OtherLICENSE