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General NPI Number Information
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NPI Number | 1750342960
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Entity Type | Individual
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Provider Name | ELIAS H BOU GAUTHIER MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 01/11/2020
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Provider Practice Location Address
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Address Line | 15J AVE BETANCES HERMANAS DAVILA
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City | BAYAMON
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State | PR
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Zip | 00959-5200
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Country | US
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Telephone | 787-361-9129
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Fax |
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Provider Business Mailing Address
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Address Line | 436 CALLE REY LUIS
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City | GUAYNABO
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State | PR
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Zip | 00969-3170
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Country | US
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Telephone | 787-790-2199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9168
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License Number State | PR
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