MEDICARE: DR. PEDRO JUAN AMADOR 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	13820	PR

General Provider Information

NPI Number	:	1407851306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO JUAN AMADOR MD

Provider Business Mailing Address
First Line	:	CONCORDIA 8118 SUITE 210
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-2027
Country	:	US
Telephone Number	:	787-841-4684
Fax Number	:	787-984-1231

Provider Business Practice Location Address
First Line	:	CONCORDIA 8118 SUITE 210
Second Line	:	GALERIA PROFESIONAL
City	:	PONCE
State	:	PR
Zip	:	00717-2027
Country	:	US
Telephone Number	:	787-841-4684
Fax Number	:	787-984-1231

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	06/23/2008

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