MEDICARE: MR. FEDERICO RODRIGUEZ PEREZ MD

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	207RI0008X	Hepatology Physician	9101	PR
2	207RG0100X	Gastroenterology Physician	9101	PR

General Provider Information

NPI Number	:	1639143480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FEDERICO RODRIGUEZ PEREZ MD

Provider Business Mailing Address
First Line	:	PO BOX 19647
Second Line	:	FERNANDEZ JUNCOS STATION
City	:	SAN JUAN
State	:	PR
Zip	:	00910-1647
Country	:	US
Telephone Number	:	787-919-7865
Fax Number	:	787-919-7868

Provider Business Practice Location Address
First Line	:	1420 CALLE AMERICO SALAS
Second Line	:	SUITE 303
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2139
Country	:	US
Telephone Number	:	787-919-7865
Fax Number	:	787-919-7868

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	03/08/2017

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