Provider Demographics
NPI:1063675478
Name:EGAS, JUAN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:EGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:JOSE
Other - Last Name:EGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2007 W SWANN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2483
Mailing Address - Country:US
Mailing Address - Phone:813-981-3382
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:17807 HUNTING BOW CIR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558
Practice Address - Country:US
Practice Address - Phone:352-515-0025
Practice Address - Fax:352-515-0174
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129841207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNFU5FOtherBLUE CROSS BLUE SHIELD
FL020516600Medicaid
FLIX730YMedicare PIN
FLIX730XMedicare PIN