Provider Demographics
NPI:1265468805
Name:PONCE GASTROENTEROLOGY SOCIETY
Entity type:Organization
Organization Name:PONCE GASTROENTEROLOGY SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-5042
Mailing Address - Street 1:450 FERROCARRIL
Mailing Address - Street 2:STA. MARIA MEDICAL STE. 210
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1105
Mailing Address - Country:US
Mailing Address - Phone:787-840-0100
Mailing Address - Fax:787-841-6849
Practice Address - Street 1:SANTA MARIA MEDICAL
Practice Address - Street 2:450 C/FERROCARRIL, STE. 210
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1105
Practice Address - Country:US
Practice Address - Phone:787-840-0100
Practice Address - Fax:787-841-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7296207R00000X
PR4589207RG0100X
PR6905207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029142Medicare ID - Type UnspecifiedMEDICARE NUMBER