Provider Demographics
NPI:1447291380
Name:CONCEPCION, JULIO MARIN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:MARIN
Last Name:CONCEPCION
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:PO BOX 2022
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-2022
Mailing Address - Country:US
Mailing Address - Phone:787-247-1714
Mailing Address - Fax:787-655-0679
Practice Address - Street 1:B6 CALLE H
Practice Address - Street 2:URB. MONTE BRISAS
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3352
Practice Address - Country:US
Practice Address - Phone:787-247-1714
Practice Address - Fax:787-655-0679
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15957208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-3681Medicare ID - Type Unspecified