Healthcare Provider Details

I. General information

NPI: 1306965892
Provider Name (Legal Business Name): ERIC T ADLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CALLE CESAR GONZALEZ STE 207
SAN JUAN PR
00918-3757
US

IV. Provider business mailing address

576 CALLE CESAR GONZALEZ STE 207
SAN JUAN PR
00918-3757
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-3361
  • Fax: 787-751-8034
Mailing address:
  • Phone: 787-751-3361
  • Fax: 787-751-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberPR12921
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: