Provider Demographics
NPI:1801980966
Name:PELET MEJIAS, JORGE I (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:I
Last Name:PELET MEJIAS
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:PMB 213
Mailing Address - Street 2:1353 RD19
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2700
Mailing Address - Country:US
Mailing Address - Phone:787-751-0887
Mailing Address - Fax:787-764-8368
Practice Address - Street 1:735 PONCE DE LEON AVE
Practice Address - Street 2:AUXILIO MUTUO HOSPITAL SUITE 708
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-751-0887
Practice Address - Fax:787-764-8368
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11123208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083606Medicaid
PR83606OtherTRIPLE S
PR0083606Medicaid
PR0083606Medicare ID - Type Unspecified