Provider Demographics
NPI:1730201617
Name:MEDEROS BROCHE, ORELBE (MD)
Entity type:Individual
Prefix:DR
First Name:ORELBE
Middle Name:
Last Name:MEDEROS BROCHE
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 939
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0939
Mailing Address - Country:US
Mailing Address - Phone:787-834-4340
Mailing Address - Fax:787-265-7750
Practice Address - Street 1:CALLE DE DIEGO E
Practice Address - Street 2:EDIF. CPR #207
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4866
Practice Address - Country:US
Practice Address - Phone:787-834-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2222983207L00000X
PR015684207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2222983OtherANESTESIOLOGY
PR2222983OtherANESTESIOLOGY