Provider Demographics
NPI:1669474318
Name:CARRERE, JUAN J (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:CARRERE
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 1:3661 S MIAMI AVE
Mailing Address - Street 2:STE 907
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4214
Mailing Address - Country:US
Mailing Address - Phone:814-371-0600
Mailing Address - Fax:814-372-4764
Practice Address - Street 1:621 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801
Practice Address - Country:US
Practice Address - Phone:814-371-0600
Practice Address - Fax:814-372-4764
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85054207RG0100X
PAMD435438207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17483XOtherMEDICARE PTAN
FL285427OtherAVMED
FL100017048OtherRAILROAD MEDICARE
FL17483OtherBCBS
FL2134161OtherUNITED HEALTHCARE
FLP00710404OtherRAILROAD MEDICARE
FL264308100Medicaid
PA412687OtherUPMC
PA000423031OtherHIGHMARK
FL0032560OtherCIGNA
PA102241660Medicaid
FL1669474318OtherTRICARE
FL7662289OtherAETNA
PA143491OtherMEDICARE PTAN
PA1616507OtherGATEWAY
FL2499134OtherGHI
PA143491OtherMEDICARE PTAN
FL17483OtherBCBS