Provider Demographics
NPI:1538178413
Name:PAGAN, ERIC N SR (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:N
Last Name:PAGAN
Suffix:SR
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 1:31 URB LOS MAESTROS
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2505
Mailing Address - Country:US
Mailing Address - Phone:787-826-6290
Mailing Address - Fax:
Practice Address - Street 1:31 URB LOS MAESTROS
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2505
Practice Address - Country:US
Practice Address - Phone:787-826-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10763208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83106OtherTRIPLE S
PR83106OtherTRIPLE S