Healthcare Provider Details

I. General information

NPI: 1801968177
Provider Name (Legal Business Name): JORGE T. BAEZ COLLADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 101 KM 16.2 LAS ARENAS, BOQUERON
CABO ROJO PR
00622-0000
US

IV. Provider business mailing address

PO BOX 6453
MAYAGUEZ PR
00681-6453
US

V. Phone/Fax

Practice location:
  • Phone: 787-255-2775
  • Fax: 787-254-1920
Mailing address:
  • Phone: 787-637-0852
  • Fax: 787-254-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14920
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: