Healthcare Provider Details

I. General information

NPI: 1356841977
Provider Name (Legal Business Name): ANTONIO ENRIQUE BURES RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

1838 CALLE ACACIA
SAN JUAN PR
00927-6712
US

V. Phone/Fax

Practice location:
  • Phone: 787-233-6558
  • Fax:
Mailing address:
  • Phone: 787-233-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number23960
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1022431
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: