Provider Demographics
NPI:1922079938
Name:SUAREZ, JOSE MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:SUAREZ
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:PO BOX 40476
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00940-0476
Mailing Address - Country:US
Mailing Address - Phone:787-982-1414
Mailing Address - Fax:
Practice Address - Street 1:COND SAN JORGE
Practice Address - Street 2:SUITE 3A
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3359
Practice Address - Country:US
Practice Address - Phone:787-982-1414
Practice Address - Fax:787-728-2335
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6519207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29833Medicare ID - Type Unspecified
PRD32377Medicare UPIN