Provider Demographics
NPI:1013999655
Name:BAUCAGE GARCIA, EDGAR (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:BAUCAGE GARCIA
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 1298
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1298
Mailing Address - Country:US
Mailing Address - Phone:787-877-3466
Mailing Address - Fax:787-877-3466
Practice Address - Street 1:CALLE CONCEPCION VERA AYALA 550
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00678-0068
Practice Address - Country:US
Practice Address - Phone:787-877-3466
Practice Address - Fax:787-877-3466
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5845208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08423Medicare UPIN
PR27517Medicare ID - Type UnspecifiedPROVEEDOR