Provider Demographics
NPI:1932261401
Name:BELARDO, JAIME ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ROBERTO
Last Name:BELARDO
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 1:200 CALLE MARGINAL
Mailing Address - Street 2:SANTA ISIDRA 2
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4179
Mailing Address - Country:US
Mailing Address - Phone:787-860-6623
Mailing Address - Fax:787-885-6129
Practice Address - Street 1:205 AVE LAURO PINERO
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2701
Practice Address - Country:US
Practice Address - Phone:787-885-4446
Practice Address - Fax:787-885-6129
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7406208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29673Medicare ID - Type Unspecified