Provider Demographics
NPI:1033305701
Name:GUEVARA, EUGENIO MOISES (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIO
Middle Name:MOISES
Last Name:GUEVARA
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 1:777 E 25TH ST STE 319
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3849
Mailing Address - Country:US
Mailing Address - Phone:305-693-8585
Mailing Address - Fax:305-693-8595
Practice Address - Street 1:777 E 25TH ST STE 319
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3849
Practice Address - Country:US
Practice Address - Phone:305-693-8585
Practice Address - Fax:305-693-8595
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108468208VP0014X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004468000Medicaid