Provider Demographics
NPI:1831118488
Name:FELICIANO PEREZ, JOSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:FELICIANO PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1282
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-1282
Mailing Address - Country:US
Mailing Address - Phone:787-842-3352
Mailing Address - Fax:787-842-3352
Practice Address - Street 1:ANTIGUO HOSPITAL SAN LUCAS
Practice Address - Street 2:CALLE GUADALUPE FINAL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-842-3352
Practice Address - Fax:787-842-3352
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR212194OtherPREFERRED HEALTH
PR3576OtherPREFERRED MEDICARE CHOICE
PR28571OtherTRIPLE S
PRC79761Medicare UPIN
PR0028571Medicare ID - Type UnspecifiedPROVIDER NUMBER