Provider Demographics
NPI:1336293620
Name:PULIDO, JUAN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:DANIEL
Last Name:PULIDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1370 13TH AVE SOUTH
Mailing Address - Street 2:SUITE 218
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-853-6154
Mailing Address - Fax:904-853-6412
Practice Address - Street 1:1370 13TH AVE SOUTH
Practice Address - Street 2:SUITE 218
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-853-6154
Practice Address - Fax:904-853-6412
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2018-10-29
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Provider Licenses
StateLicense IDTaxonomies
FLME102087207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022274400Medicaid
FL004596901Medicaid