Provider Demographics
NPI:1144252198
Name:INSTITUTO DE ENDOSCOPIA DIGESTIVA DEL SUR
Entity type:Organization
Organization Name:INSTITUTO DE ENDOSCOPIA DIGESTIVA DEL SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-848-5897
Mailing Address - Street 1:450 C/FERROCARRIL, STE. 216
Mailing Address - Street 2:SANTA MARIA MEDICAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1105
Mailing Address - Country:US
Mailing Address - Phone:787-848-5897
Mailing Address - Fax:787-284-4197
Practice Address - Street 1:450 C/FERROCARRIL, STE. 216
Practice Address - Street 2:SANTA MARIA MEDICAL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1105
Practice Address - Country:US
Practice Address - Phone:787-848-5897
Practice Address - Fax:787-284-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6905207RG0100X
PR4589207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081029Medicare ID - Type Unspecified