Provider Demographics
NPI:1376719971
Name:GUEVARA-GARAY, HECTOR ESTEBAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:ESTEBAN
Last Name:GUEVARA-GARAY
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 1:13438 FORT KING RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5214
Mailing Address - Country:US
Mailing Address - Phone:352-567-5266
Mailing Address - Fax:352-567-3066
Practice Address - Street 1:13438 FORT KING RD
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5214
Practice Address - Country:US
Practice Address - Phone:352-567-5266
Practice Address - Fax:352-567-3066
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 103575261QP2300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001330200Medicaid
FLP00846842OtherRAILROAD MEDICARE
FL4838272Medicare UPIN
FLCK760ZMedicare PIN