MEDICARE: RGD MEDICAL GROUP

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	174400000X	Specialist
2	261QC1500X	Community Health Clinic/Center	17940	PR
3	261QM2500X	Medical Specialty Clinic/Center	17940	PR

General Provider Information

NPI Number	:	1558682849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RGD MEDICAL GROUP

Provider Business Mailing Address
First Line	:	109 CALLE GUAYAMA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-4512
Country	:	US
Telephone Number	:	787-989-5593
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 CALLE GUAYAMA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-4512
Country	:	US
Telephone Number	:	787-989-5593
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. ALEX DANIEL ANDUJAR
Credential	:	M.D.
Telephone Number	:	787-989-5593

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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