MEDICARE: DR. AGUSTIN J RODRIGUEZ-SURO 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	207R00000X	Internal Medicine Physician	7464	PR

General Provider Information

NPI Number	:	1134125925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGUSTIN J RODRIGUEZ-SURO MD

Provider Business Mailing Address
First Line	:	PO BOX 19206
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-1206
Country	:	US
Telephone Number	:	787-579-5829
Fax Number	:	787-281-7615

Provider Business Practice Location Address
First Line	:	1056 AVE MUNOZ RIVERA
Second Line	:	SUITE 610 FIRST BANK BLDG.
City	:	SAN JUAN
State	:	PR
Zip	:	00927-5015
Country	:	US
Telephone Number	:	787-772-4669
Fax Number	:	787-281-7615

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

Provider Enumeration Date	:	06/26/2005
Last Update Date	:	04/14/2024

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