MEDICARE: JAIME MARRERO RUSSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	07949	PR

General Provider Information

NPI Number	:	1619053519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME MARRERO RUSSE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4215
Second Line	:
City	:	VEGA BAJA
State	:	PR
Zip	:	00694-4215
Country	:	US
Telephone Number	:	787-855-8624
Fax Number	:	787-650-1030

Provider Business Practice Location Address
First Line	:	55 CALLE PALMA
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-4526
Country	:	US
Telephone Number	:	787-855-8624
Fax Number	:	787-650-1030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	06/24/2013

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