Provider Demographics
NPI:1275500373
Name:GUERRERO, JUAN M (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:GUERRERO
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 1:12221 MOPAC EXPRESSWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2483
Mailing Address - Country:US
Mailing Address - Phone:512-901-4016
Mailing Address - Fax:512-901-3857
Practice Address - Street 1:2400 CEDAR BEND DR.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2483
Practice Address - Country:US
Practice Address - Phone:512-901-4016
Practice Address - Fax:512-901-3857
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137122103Medicaid
TX8L25562Medicare PIN
TX137122103Medicaid
TX370001668Medicare PIN
TX88G225Medicare PIN