MEDICARE: DR. EDUARDO E ENCARNACION CONCEPCION

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	208D00000X	General Practice Physician	15210	PR

General Provider Information

NPI Number	:	1063449379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO E ENCARNACION CONCEPCION

Provider Business Mailing Address
First Line	:	PO BOX 1537
Second Line	:
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-1537
Country	:	US
Telephone Number	:	787-280-1335
Fax Number	:	787-280-1335

Provider Business Practice Location Address
First Line	:	126 CALLE PAVIA FERNANDEZ
Second Line	:
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-1537
Country	:	US
Telephone Number	:	787-280-1335
Fax Number	:	787-280-1335

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/18/2017

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