Provider Demographics
NPI:1447480918
Name:ALMODOVAR-MERCADO, GUSTAVO JESUS (MD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:JESUS
Last Name:ALMODOVAR-MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUSTAVO
Other - Middle Name:J
Other - Last Name:ALMODOVAR MERCADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1202 CALLE BARTOLO RIVERA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7757
Mailing Address - Country:US
Mailing Address - Phone:787-454-1350
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE DE DIEGO E STE 205
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5080
Practice Address - Country:US
Practice Address - Phone:787-986-7300
Practice Address - Fax:787-986-7302
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279464207Y00000X
PR19245207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology