MEDICARE: DR. WALDEMAR CHARLES RIOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	14760	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	2879	OTHER	PR	PREFERRED MEDICARE CHOICE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212899	OTHER	PR	PREFERRED HEALTH
2	22925	OTHER	PR	TRIPLE S
3	300129	OTHER	PR	MMM
4	PE4854	OTHER	PR	PALIC
5	100679	OTHER	PR	CRUZ AZUL
7	9180625	OTHER	PR	HUMANA

General Provider Information

NPI Number	:	1003884065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALDEMAR CHARLES RIOS M.D.

Provider Business Mailing Address
First Line	:	400 AVE DOMENECH
Second Line	:	SUITE 607
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-250-0084
Fax Number	:	787-772-7731

Provider Business Practice Location Address
First Line	:	400 AVE DOMENECH
Second Line	:	SUITE 607
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-250-0084
Fax Number	:	787-250-2181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	04/02/2012

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Directions to “ DR. WALDEMAR CHARLES RIOS M.D.” Practice Location

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