Provider Demographics
NPI:1982609996
Name:BUXEDA, ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:BUXEDA
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 1:29 CALLE WASHINGTON
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1509
Mailing Address - Country:US
Mailing Address - Phone:787-723-0931
Mailing Address - Fax:787-723-0931
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:STE 110
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1509
Practice Address - Country:US
Practice Address - Phone:787-723-0931
Practice Address - Fax:787-723-0931
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7525207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78261Medicare UPIN