Provider Demographics
NPI:1770562308
Name:LABOY PABON, MIGUEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:LABOY PABON
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 1:181 CALLE ALTO
Mailing Address - Street 2:URB CUIDAD JARDINES DE GURABO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-3355
Mailing Address - Country:US
Mailing Address - Phone:787-638-0280
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3112
Practice Address - Country:US
Practice Address - Phone:787-734-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15444146D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1770562308Medicaid