Provider Demographics
NPI:1558485771
Name:DE JESUS, RAMON (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:DE JESUS
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 521
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0521
Mailing Address - Country:US
Mailing Address - Phone:787-264-4433
Mailing Address - Fax:787-264-4433
Practice Address - Street 1:151 AVE UNIV INTERAMERICANA
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4332
Practice Address - Country:US
Practice Address - Phone:787-264-4433
Practice Address - Fax:787-892-0301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14846207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI 15136Medicare UPIN
PR0084925Medicare ID - Type Unspecified