Provider Demographics
NPI:1841375375
Name:FLAQUE, JOSE F (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:F
Last Name:FLAQUE
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 1:1005 CALLE HARVARD
Mailing Address - Street 2:UNIVERSITY GDNS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4821
Mailing Address - Country:US
Mailing Address - Phone:787-763-2348
Mailing Address - Fax:787-269-3245
Practice Address - Street 1:BAYAMON MEDICAL PLAZA CARRETERA 2,KM.11.3
Practice Address - Street 2:OFICINA 911
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-269-3245
Practice Address - Fax:787-269-3245
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98643Medicare ID - Type Unspecified
PRD83357Medicare UPIN