Provider Demographics
NPI:1124219399
Name:JUAN P DUARTE MD, PA
Entity Type:Organization
Organization Name:JUAN P DUARTE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-278-9677
Mailing Address - Street 1:18926 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7711
Mailing Address - Country:US
Mailing Address - Phone:305-278-9677
Mailing Address - Fax:305-278-7757
Practice Address - Street 1:18926 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7711
Practice Address - Country:US
Practice Address - Phone:305-278-9677
Practice Address - Fax:305-278-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82779208D00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5521Medicare PIN