Provider Demographics
NPI:1821073495
Name:MARRERO RUSSE, JOSE RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAMON
Last Name:MARRERO RUSSE
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:CALLE ACAPULCO 1005
Mailing Address - Street 2:MIRAMAR
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0001
Mailing Address - Country:US
Mailing Address - Phone:787-360-2717
Mailing Address - Fax:
Practice Address - Street 1:15 E AVE PADRE RIVERA
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-0001
Practice Address - Country:US
Practice Address - Phone:787-852-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77680Medicare UPIN