Provider Demographics
NPI:1841491321
Name:MELENDEZ HERNANDEZ, JORGE DAVID (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:DAVID
Last Name:MELENDEZ HERNANDEZ
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:PO BOX 270208
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-0208
Mailing Address - Country:US
Mailing Address - Phone:787-308-6859
Mailing Address - Fax:
Practice Address - Street 1:CALLE ELLIOT VELEZ B-43, URBANIZACION ATENAS
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-854-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16955207R00000X, 207RG0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice