Active NPI
Wagner Gervais
- Adolescent Medicine (Family Medicine) Physician
- San Juan, PR
National Provider Identifier
1518596295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adolescent Medicine (Family Medicine) Physician
- License
- 258-PA
- Practice address
- 151 Calle Las Lomas
San Juan, PR 00926-5527 - Phone
- (956) 578-6712
- NPI assigned
- Apr 5, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adolescent Medicine (Family Medicine) Physician | 207QA0000X | 258-PA | PR | Primary |
Addresses
Primary practice location
151 Calle Las Lomas
San Juan, PR 00926-5527
Mailing address
151 Calle Las Lomas
San Juan, PR 00926-5527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 258-PA | PR | MD | Adolescent Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586044800000",
"number": "1518596295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 CALLE LAS LOMAS",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009265527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 CALLE LAS LOMAS",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009265527",
"telephone_number": "956-578-6712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERVAIS",
"first_name": "WAGNER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-05",
"last_updated": "2020-04-05",
"certification_date": "2020-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0000X",
"taxonomy_group": "",
"desc": "Family Medicine, Adolescent Medicine",
"state": "PR",
"license": "258-PA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.