Healthcare Provider Details

I. General information

NPI: 1699183129
Provider Name (Legal Business Name): JOSE CONCEPCION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON # 37.5
SAN JUAN PR
00917-5032
US

IV. Provider business mailing address

PO BOX 12302
SAN JUAN PR
00914-0302
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-758-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19140
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberV2046
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number19140
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: