Provider Demographics
NPI:1205810546
Name:GILES, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GILES
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 7023
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7023
Mailing Address - Country:US
Mailing Address - Phone:787-843-6710
Mailing Address - Fax:787-841-6818
Practice Address - Street 1:4132 CALLE AURORA
Practice Address - Street 2:SUITE 101
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1254
Practice Address - Country:US
Practice Address - Phone:787-843-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4103207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR95180OtherTRIPLE-S
PR063850OtherCRUZ AZUL
PR7320027OtherHUMANA
PR1972OtherIMC
PR200055OtherMMM
PR95180OtherTRIPLE-S
PRD08669Medicare UPIN