MEDICARE: OSMAR CREAGH BANDERA 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	207L00000X	Anesthesiology Physician	12565-I	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518282946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSMAR CREAGH BANDERA MD

Provider Business Mailing Address
First Line	:	PO BOX 2116
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00922-2116
Country	:	US
Telephone Number	:	787-248-7977
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIVERSITY DISTRICT HOSPITAL
Second Line	:	PUERTO RICO MEDICAL CENTER BO. MONACILLOS
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00935-0001
Country	:	US
Telephone Number	:	787-754-0101
Fax Number	:

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

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/29/2010

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