Provider Demographics
NPI:1972618486
Name:RICHARDS, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:RICHARDS
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 1:5546 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1036
Mailing Address - Country:US
Mailing Address - Phone:407-673-5528
Mailing Address - Fax:407-678-1189
Practice Address - Street 1:5546 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1036
Practice Address - Country:US
Practice Address - Phone:407-673-5528
Practice Address - Fax:407-678-1189
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92087OtherBLUECROSSBLUESHIELD
FL4074232OtherAETNA
FLD59930Medicare UPIN
FL92087OtherBLUECROSSBLUESHIELD