Provider Demographics
NPI:1023019833
Name:BUSTILLO, JUAN C (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:BUSTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3301 SW 34TH CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-6619
Mailing Address - Country:US
Mailing Address - Phone:352-861-0100
Mailing Address - Fax:352-861-1119
Practice Address - Street 1:3301 SW 34TH CIR STE 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6619
Practice Address - Country:US
Practice Address - Phone:352-861-0100
Practice Address - Fax:352-861-1119
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69798207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379937900Medicaid
FL379937900Medicaid
FL28391ZMedicare PIN