Provider Demographics
NPI:1225079056
Name:BOLET, JUAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:BOLET
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3661 S MIAMI AVENUE
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133
Mailing Address - Country:US
Mailing Address - Phone:305-856-4153
Mailing Address - Fax:305-856-4508
Practice Address - Street 1:3661 S MIAMI AVENUE
Practice Address - Street 2:SUITE 1003
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-856-4153
Practice Address - Fax:305-856-4508
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL13524208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047013900Medicaid
D59037Medicare UPIN
FL90073Medicare ID - Type Unspecified