Doctor Name: | DR. SAMUEL NEGRON AGOSTO |
NPI Number: | 1164525465 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 11991 |
Business Practice Address: | Calle Cipres #706 Local #2 Fajardo Gardens Fajardo, PR - 00738 |
Business Phone Number: | 7878014698 |
Business Fax Number: | 7878014698 |
Mailing Address: | Po Box 1666, FAJARDO |
State: | PR |
Postal Code: | 007381666 |
Phone Number: | 7878014698 |
Fax Number: | 7878014698 |
NPI Enumeration Date: | 09/06/2006 |
NPI Last Update Date: | 12/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 11991 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |