Provider Demographics
NPI:1740300839
Name:LAUREANO LANDRON, IDAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:IDAMAR
Middle Name:
Last Name:LAUREANO LANDRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:39 STREET SANTA JUANITA
Mailing Address - Street 2:PMB 334 UU1
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-396-7423
Mailing Address - Fax:787-288-1115
Practice Address - Street 1:LOTE 1METRO OFFICE PARK
Practice Address - Street 2:SUITE 400
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-774-3344
Practice Address - Fax:787-774-6251
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR11704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11704OtherMEDICAL LICENSE
PR1625033OtherLICENCIA DE CHOFER