Provider Demographics
NPI:1407836232
Name:SERPA, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SERPA
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 1:1800 W 68TH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4406
Mailing Address - Country:US
Mailing Address - Phone:305-698-9077
Mailing Address - Fax:305-827-4925
Practice Address - Street 1:1800 W 68TH ST STE 115
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4406
Practice Address - Country:US
Practice Address - Phone:305-698-9077
Practice Address - Fax:305-827-4925
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79847208VP0000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262296300Medicaid
FL01114OtherBCBS OF FL
FL01114YMedicare PIN
FL01114OtherBCBS OF FL
FL01114ZMedicare PIN
FL01114VMedicare PIN
FL262296300Medicaid