Provider Demographics
NPI:1770656993
Name:FEIJOO-GONZALEZ, JOSE E (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:FEIJOO-GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ALTURAS DE TORRIMAR
Mailing Address - Street 2:11-21 CALLE 9
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3213
Mailing Address - Country:US
Mailing Address - Phone:787-799-2080
Mailing Address - Fax:787-272-4209
Practice Address - Street 1:COMERCIAL BELLA VISTA GARDENS
Practice Address - Street 2:EDIF 3 LOCAL 12-A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-799-2080
Practice Address - Fax:787-272-4209
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6139208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD99599Medicare UPIN