Provider Demographics
NPI:1902036924
Name:MAYO, ENRIQUE JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:JOSE
Last Name:MAYO
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 53 MARBELLA
Mailing Address - Street 2:ROYAL CENTER #339
Mailing Address - City:PANAMA
Mailing Address - State:PANAMA
Mailing Address - Zip Code:8450
Mailing Address - Country:PA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:APARTADO 8470 ZONA 7
Practice Address - Street 2:
Practice Address - City:PANAMA
Practice Address - State:PANAMA
Practice Address - Zip Code:7
Practice Address - Country:PA
Practice Address - Phone:507-263-4007
Practice Address - Fax:507-263-8517
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76878207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine