Healthcare Provider Details

I. General information

NPI: 1972560993
Provider Name (Legal Business Name): MILTON GEORGE GARLAND CANSOBRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 848, KM 1.0 BO. SAINT JUST
TUJILLO ALTO PR
00978
US

IV. Provider business mailing address

P O BOX 340, SAINT JUST STATION
TUJILLO ALTO PR
00978
US

V. Phone/Fax

Practice location:
  • Phone: 787-300-3188
  • Fax: 787-300-3432
Mailing address:
  • Phone: 787-300-3188
  • Fax: 787-300-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10316
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: