Provider Demographics
NPI:1780802900
Name:GOMES DE BRITO, JOSE VALMIR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:VALMIR
Last Name:GOMES DE BRITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VALMIR
Other - Middle Name:G
Other - Last Name:DE BRITO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:MANSIONES DE VILLANOVA
Mailing Address - Street 2:K-25 CALLE UNO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-720-5160
Mailing Address - Fax:787-720-5160
Practice Address - Street 1:MANSIONES DE VILLANOVA
Practice Address - Street 2:K-25 CALLE UNO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-720-5160
Practice Address - Fax:787-720-5160
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5090208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064944OtherCRUZ AZUL
PR2-5537OtherTRIPLE S
PR2-5537OtherTRIPLE S