Provider Demographics
NPI:1689809964
Name:LOPEZ-GUZMAN, JUAN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:LOPEZ-GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:J
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2010 59TH ST W STE 4200
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4687
Mailing Address - Country:US
Mailing Address - Phone:941-794-3999
Mailing Address - Fax:
Practice Address - Street 1:2010 59TH ST W STE 4200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4687
Practice Address - Country:US
Practice Address - Phone:941-794-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131811207RC0000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022711600Medicaid
FLBCBSOtherQB9JR