Provider Demographics
NPI:1871709618
Name:BIDOT DE JESUS, PEDRO LUIS (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:LUIS
Last Name:BIDOT DE JESUS
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 1218
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1218
Mailing Address - Country:US
Mailing Address - Phone:787-607-3379
Mailing Address - Fax:787-820-5508
Practice Address - Street 1:JARDINES DEL JUNCO 9
Practice Address - Street 2:BO HATO ARRIBA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614
Practice Address - Country:US
Practice Address - Phone:787-607-3379
Practice Address - Fax:787-820-5508
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9437208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice