Provider Demographics
NPI:1669415709
Name:TAVAREZ BORRELL, JOSE R (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:TAVAREZ BORRELL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:355 CALLE CITADEL
Mailing Address - Street 2:REPARTO UNIVERSITARIO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1824
Mailing Address - Country:US
Mailing Address - Phone:787-767-1593
Mailing Address - Fax:
Practice Address - Street 1:124 AVE WINSTON CHURCHILL
Practice Address - Street 2:EDIF EL SENORIAL, OFICINA 310
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-6064
Practice Address - Country:US
Practice Address - Phone:787-274-2862
Practice Address - Fax:787-274-2862
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-02-21
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Provider Licenses
StateLicense IDTaxonomies
PR14299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine