Provider Demographics
NPI:1790040780
Name:FEBRES VALECILLOS, JUAN MANUEL (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:FEBRES VALECILLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:MANUEL
Other - Last Name:FEBRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5730
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:888-402-7256
Mailing Address - Fax:888-902-1099
Practice Address - Street 1:311 CAMDEN ST STE 409
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2014
Practice Address - Country:US
Practice Address - Phone:210-228-9605
Practice Address - Fax:210-228-9632
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD234202086S0102X, 208600000X
TXU1892208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care