Provider Demographics
NPI:1275518201
Name:DEGUZMAN, MARY JEAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY JEAN
Middle Name:S
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12596 NW 67TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1961
Mailing Address - Country:US
Mailing Address - Phone:954-340-7041
Mailing Address - Fax:
Practice Address - Street 1:895 SW 30TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4887
Practice Address - Country:US
Practice Address - Phone:954-633-3387
Practice Address - Fax:954-633-3217
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70419207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252471200Medicaid
FL220019667OtherRR MEDICARE
FLF40276Medicare UPIN
FL41622Medicare PIN