MEDICARE: DR. NELSON R MEDINA 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	207RG0100X	Gastroenterology Physician	12324	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	600932	OTHER	PR	MEDICARE Y MUCHO MAS

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
2	403255022	OTHER	PR	PROSAM
4	09312324	OTHER	PR	GLOBAL HEATH
5	214131	OTHER	PR	PREFERRED MEDICAL
6	3561	OTHER	PR	FISRT MEDICAL
7	1808	OTHER	PR	PREFERRED MEDICAL CHOICE
8	5012324	OTHER	PR	AUTORIDAD DE ACUEDUCTOS
9	SE4203	OTHER	PR	PALIC
10	061067	OTHER	PR	CRUZ AZUL DE PR

General Provider Information

NPI Number	:	1770543514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON R MEDINA M.D.

Provider Business Mailing Address
First Line	:	P O BOX 332228
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00733-2228
Country	:	US
Telephone Number	:	787-813-2385
Fax Number	:	787-984-1691

Provider Business Practice Location Address
First Line	:	311 TORRE SAN CRISTOBAL
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2856
Country	:	US
Telephone Number	:	787-813-2385
Fax Number	:	787-984-1691

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/07/2023

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