Provider Demographics
NPI:1093795692
Name:GUZMAN, JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:GUZMAN
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 1:220 N. SYKES CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32955
Mailing Address - Country:US
Mailing Address - Phone:321-459-1446
Mailing Address - Fax:321-452-1261
Practice Address - Street 1:709 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1938
Practice Address - Country:US
Practice Address - Phone:321-725-2225
Practice Address - Fax:321-308-0635
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46149207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24981416OtherCIGNA
FL05564OtherFLORIDA BLUE (BCBS)
FL042035200Medicaid
FL0623402OtherAETNA
FL24981416OtherCIGNA
FLD51354Medicare UPIN