Provider Demographics
NPI:1265639249
Name:GELDRES, JUAN JULIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JULIO
Last Name:GELDRES
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 1:660 RALPH MCGILL BLVD NE
Mailing Address - Street 2:#2613
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1149
Mailing Address - Country:US
Mailing Address - Phone:586-306-5788
Mailing Address - Fax:
Practice Address - Street 1:660 RALPH MCGILL BLVD NE
Practice Address - Street 2:#2613
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1149
Practice Address - Country:US
Practice Address - Phone:586-306-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066492207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology