Provider Demographics
NPI:1295743367
Name:MARRERO DE GRACIA, ERNESTO X (MD)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:X
Last Name:MARRERO DE GRACIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERNESTO
Other - Middle Name:X
Other - Last Name:MARRERO DE GRACIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:C/2 R-11
Mailing Address - Street 2:SAN SOUCI
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-599-1174
Mailing Address - Fax:
Practice Address - Street 1:INSTITUTO SAN PABLO
Practice Address - Street 2:SUITE 507 CALLE SANTA CRUZ #66
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-2010
Practice Address - Fax:787-740-8377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine