Provider Demographics
NPI:1174591093
Name:CARBALLO DURAN, FRANCISCO R (MD)
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:R
Last Name:CARBALLO DURAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:185 CANDELERO DR APT 608
Mailing Address - Street 2:FAIRLAKES VILLAGE
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6133
Mailing Address - Country:US
Mailing Address - Phone:787-518-0104
Mailing Address - Fax:
Practice Address - Street 1:13 CALLE FLOR GERENA N
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4288
Practice Address - Country:US
Practice Address - Phone:787-518-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9110030OtherHUMANA
PR212353OtherPREFERRED HEALTH
PR80952-CAOtherTRIPLE S
PRP070OtherFIRST MEDICAL
PR11-1015-2OtherACAA
PR80952-CAOtherTRIPLE S
PRP070OtherFIRST MEDICAL