Provider Demographics
NPI:1891821815
Name:PAGAN CALO, GUILLERMO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:A
Last Name:PAGAN CALO
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:PMB 154 PO BOX 5103
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-384-6716
Mailing Address - Fax:787-849-3845
Practice Address - Street 1:PLAZA CONSTANCIA SEGUNDO PISO
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-3845
Practice Address - Fax:787-849-3845
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14386208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22950Medicare ID - Type Unspecified