Provider Demographics
NPI:1780663252
Name:HERRAN, JUAN J (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:HERRAN
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 1:717 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4645
Mailing Address - Country:US
Mailing Address - Phone:407-515-8585
Mailing Address - Fax:407-575-8584
Practice Address - Street 1:1697 LAKE BALDWIN LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814
Practice Address - Country:US
Practice Address - Phone:407-515-8585
Practice Address - Fax:407-575-8584
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41261207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06837100Medicaid
FLA49397Medicare UPIN
FL47607CMedicare ID - Type Unspecified