Provider Demographics
NPI:1326016536
Name:GUERRERO, IVAN A (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:A
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:P.O. BOX 551272
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1272
Mailing Address - Country:US
Mailing Address - Phone:904-646-1987
Mailing Address - Fax:904-646-1501
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 802
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-646-1987
Practice Address - Fax:904-646-1501
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82361207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5718AMedicare PIN
H40248Medicare UPIN