Provider Demographics
NPI:1073705158
Name:MONSERRATE, JUAN RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:RAMON
Last Name:MONSERRATE
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 1:6185 HAWKES BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3422
Mailing Address - Country:US
Mailing Address - Phone:954-434-4713
Mailing Address - Fax:954-434-4713
Practice Address - Street 1:6185 HAWKES BLUFF AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-3422
Practice Address - Country:US
Practice Address - Phone:954-434-4713
Practice Address - Fax:954-434-4713
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 58716174400000X
FLME58716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist