Healthcare Provider Details

I. General information

NPI: 1528105046
Provider Name (Legal Business Name): SHIRLEY PAGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST JOSE C BARBOSA #62
SALINAS PR
00751
US

IV. Provider business mailing address

PO BOX 328
SANTA ISABEL PR
00757-0328
US

V. Phone/Fax

Practice location:
  • Phone: 787-824-5634
  • Fax:
Mailing address:
  • Phone: 787-824-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice
License Number11485
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDM11141-9
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSTATE LICENSE
# 2
Identifier11485
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSTATE MEDICAL LICENSE
# 3
IdentifierBP5328833
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerDEA LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: