Provider Demographics
NPI:1568493369
Name:SANCHEZ-HUMALA, JUAN (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:SANCHEZ-HUMALA
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 1:4520 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1957
Mailing Address - Country:US
Mailing Address - Phone:352-597-2222
Mailing Address - Fax:352-596-6924
Practice Address - Street 1:4520 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1957
Practice Address - Country:US
Practice Address - Phone:352-597-2222
Practice Address - Fax:352-596-6924
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 20960207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062440301Medicaid
FL062440300Medicaid
D62749Medicare UPIN
FL062440301Medicaid