MEDICARE: DR. LUIS ANTONIO PAGAN 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	208D00000X	General Practice Physician	12215	PR

General Provider Information

NPI Number	:	1831155092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ANTONIO PAGAN MD

Provider Business Mailing Address
First Line	:	349 CALLE MENDEZ VIGO STE 10
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-4978
Country	:	US
Telephone Number	:	787-278-1062
Fax Number	:	787-278-1062

Provider Business Practice Location Address
First Line	:	CALLE MENDEZ VIGO
Second Line	:	PABELLON RHC
City	:	DORADO
State	:	PR
Zip	:	00646-4924
Country	:	US
Telephone Number	:	787-387-3333
Fax Number	:

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	10/28/2019

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