Provider Demographics
NPI:1871539932
Name:IBARRA, EDUARDO (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:IBARRA
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 1869
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1869
Mailing Address - Country:US
Mailing Address - Phone:787-735-8900
Mailing Address - Fax:787-735-3040
Practice Address - Street 1:204 CALLE JULIO CINTRON
Practice Address - Street 2:SUITE 224
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3311
Practice Address - Country:US
Practice Address - Phone:787-735-8900
Practice Address - Fax:787-735-3040
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7701207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10382Medicare ID - Type Unspecified
PRE08567Medicare UPIN