Provider Demographics
NPI:1821195231
Name:DIXON SELLES, PAUL H (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:DIXON SELLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 CALLE AMATISTA
Mailing Address - Street 2:VILLA BLANCA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-719-4100
Mailing Address - Fax:787-719-4101
Practice Address - Street 1:61A CALLE DOLORES CABRERA
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-0000
Practice Address - Country:US
Practice Address - Phone:787-719-4100
Practice Address - Fax:787-719-4101
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9418208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE81681Medicare UPIN
PR0081312Medicare ID - Type Unspecified