Provider Demographics
NPI:1154305902
Name:CACERES, JUAN FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:FERNANDO
Last Name:CACERES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-985-8884
Mailing Address - Fax:361-985-9935
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-985-8884
Practice Address - Fax:361-985-9935
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8817207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2320788OtherAETNA INSURANCE COMPANY
TX127431803Medicaid
0017CLOtherBLUE CROSS BLUE SHIELD
TX00107DMedicare ID - Type Unspecified
TX2320788OtherAETNA INSURANCE COMPANY