MEDICARE: DR. EDGAR R SERRA MD

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	208600000X	Surgery Physician	4943	PR

General Provider Information

NPI Number	:	1053416404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR R SERRA MD

Provider Business Mailing Address
First Line	:	25 AVE SEVERIANO CUEVAS
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603-5713
Country	:	US
Telephone Number	:	787-891-8090
Fax Number	:	787-891-8190

Provider Business Practice Location Address
First Line	:	25 AVE SEVERIANO CUEVAS
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603-5713
Country	:	US
Telephone Number	:	787-891-8090
Fax Number	:	787-891-8190

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	06/07/2026

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