Provider Demographics
NPI:1801968177
Name:BAEZ COLLADO, JORGE T (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:T
Last Name:BAEZ COLLADO
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 6453
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6453
Mailing Address - Country:US
Mailing Address - Phone:787-637-0852
Mailing Address - Fax:787-254-1920
Practice Address - Street 1:CARR. 101 KM 16.2
Practice Address - Street 2:LAS ARENAS, BOQUERON
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00622-0000
Practice Address - Country:US
Practice Address - Phone:787-255-2775
Practice Address - Fax:787-254-1920
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14920208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH96585Medicare UPIN
PR22001Medicare ID - Type Unspecified