Provider Demographics
NPI:1891059747
Name:AGRAIT GONZALEZ, MIGUEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:F
Last Name:AGRAIT GONZALEZ
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 1:1511 AVE PONCE DE LEON STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-5001
Mailing Address - Country:US
Mailing Address - Phone:787-314-4246
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON MEDICAL CENTER EMERGENCY DEPARTMENT
Practice Address - Street 2:PR #2, KM 11.7
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-620-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19042207P00000X, 207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5597070300Medicaid