MEDICARE: ROBERT BOADA 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	207W00000X	Ophthalmology Physician	13255	PR
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	13255	PR

General Provider Information

NPI Number	:	1578527396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BOADA MD

Provider Business Mailing Address
First Line	:	1 RODRIGUEZ SERRA ST #401
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1496
Country	:	US
Telephone Number	:	787-251-5280
Fax Number	:	787-785-3617

Provider Business Practice Location Address
First Line	:	1845 CARR 2 STE 810
Second Line	:	BAYAMON MEDICAL PLAZA
City	:	BAYAMON
State	:	PR
Zip	:	00959-7206
Country	:	US
Telephone Number	:	787-251-5280
Fax Number	:	787-785-3617

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	04/05/2017

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Directions to “ ROBERT BOADA MD” Practice Location

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