Provider Demographics
NPI:1386649812
Name:PINEDA, JUAN JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JOSE
Last Name:PINEDA
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 1:3300 VAWTER SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8609
Mailing Address - Country:US
Mailing Address - Phone:573-445-9764
Mailing Address - Fax:
Practice Address - Street 1:3300 VAWTER SCHOOL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-8609
Practice Address - Country:US
Practice Address - Phone:573-445-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3P42207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO251779OtherHEALTHLINK
MO6520OtherBLUE CROSS/BLUE SHIELD/MO
MO206996613Medicaid
MO110212405OtherRAILROAD MEDICARE
MO6520OtherBLUE CROSS/BLUE SHIELD/MO
MO110212405OtherRAILROAD MEDICARE
MO206996613Medicaid