Provider Demographics
NPI:1598705683
Name:CAZANO, JUAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:B
Last Name:CAZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:BAUTISTA
Other - Last Name:CAZANO-BARREIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-0083
Mailing Address - Country:US
Mailing Address - Phone:870-857-3399
Mailing Address - Fax:870-857-3301
Practice Address - Street 1:1300 CREASON RD
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-1716
Practice Address - Country:US
Practice Address - Phone:870-857-3399
Practice Address - Fax:870-857-3301
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-3904208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11515501Medicaid
AR52495Medicare ID - Type Unspecified
AR11515501Medicaid