Provider Demographics
NPI:1013971712
Name:FELICIANO, WILLIAM (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:42 CALLE YAGRUMO
Mailing Address - Street 2:CIUDAD JARDIN III
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4867
Mailing Address - Country:US
Mailing Address - Phone:787-730-7763
Mailing Address - Fax:787-779-8491
Practice Address - Street 1:BAYAMON MEDICAL MALL
Practice Address - Street 2:SUITE 708
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-787-5813
Practice Address - Fax:787-779-8491
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4102207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3404102OtherU.I.A.
PR6745OtherFIRST MEDICAL
PR6200091OtherHUMANA HEALTH PLAN
PR6200091OtherHUMANA INS.
PR825623OtherMMM
PR24829FEOtherTRIPLE-S
PR063458OtherBLUE CROSS
PR6200091OtherHUMANA HEALTH PLAN
PR6745OtherFIRST MEDICAL