Provider Demographics
NPI:1013986041
Name:OCHOA, JUAN GONZALO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:GONZALO
Last Name:OCHOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:GONZALO
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-665-5108
Mailing Address - Fax:251-660-5792
Practice Address - Street 1:1601 CENTER STREET
Practice Address - Street 2:STE. 2S
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-660-5108
Practice Address - Fax:251-660-5792
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0466312084N0400X
ALAL302882084N0400X
AL302882084N0600X, 2084N0400X
FLME799982084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000797332AMedicaid
GA000797332BMedicaid
FL130018720OtherRAILROAD MEDICARE
FL2547317-00Medicaid
GA000797332AMedicaid
FL43973ZMedicare PIN
FLG73142Medicare UPIN