Healthcare Provider Details

I. General information

NPI: 1023069986
Provider Name (Legal Business Name): JOSE M SANCHEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DE VETERANO PONCE VA OUTPATIENT CLINIC
PONCE PR
00716-2001
US

IV. Provider business mailing address

PO BOX 360339
SAN JUAN PR
00936-0339
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax: 787-651-4321
Mailing address:
  • Phone: 787-812-3030
  • Fax: 787-651-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number7613
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number39215
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101048376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: