Healthcare Provider Details

I. General information

NPI: 1114122207
Provider Name (Legal Business Name): DAVID JOHN CALVESBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NA6 CALLE MIRAMONTE GARDEN HILLS
GUAYNABO PR
00966-2009
US

IV. Provider business mailing address

NA6 CALLE MIRAMONTE GARDEN HILLS
GUAYNABO PR
00966-2009
US

V. Phone/Fax

Practice location:
  • Phone: 423-557-9264
  • Fax:
Mailing address:
  • Phone: 423-557-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number9950
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: