MEDICARE: DR. GABRIEL LABORDE CORRETJER M.D.

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	208D00000X	General Practice Physician	12694	PR

General Provider Information

NPI Number	:	1730122433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL LABORDE CORRETJER M.D.

Provider Business Mailing Address
First Line	:	1679 CALLE TINTO
Second Line	:	URB. RIO PIEDRAS HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3233
Country	:	US
Telephone Number	:	787-370-1519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1679 CALLE TINTO
Second Line	:	URB. RIO PIEDRAS HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3233
Country	:	US
Telephone Number	:	787-370-1519
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/08/2013

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