Provider Demographics
NPI:1396769253
Name:MENDEZ NEGRON, EDGAR (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:MENDEZ NEGRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1706
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1706
Mailing Address - Country:US
Mailing Address - Phone:787-868-5857
Mailing Address - Fax:787-868-5857
Practice Address - Street 1:BO ASOAMANTE CARR 115
Practice Address - Street 2:AVE ROTARIO KM 22.4
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00604
Practice Address - Country:US
Practice Address - Phone:787-868-5857
Practice Address - Fax:787-868-5857
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI32371Medicare UPIN