Provider Demographics
NPI:1396833380
Name:JUAN, ANTONIO M (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:M
Last Name:JUAN
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 1:750 SW 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1307
Mailing Address - Country:US
Mailing Address - Phone:305-448-4002
Mailing Address - Fax:305-448-1956
Practice Address - Street 1:750 SW 49TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1307
Practice Address - Country:US
Practice Address - Phone:305-448-4002
Practice Address - Fax:305-448-1956
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0025128207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO085029Medicare UPIN
FL12042AMedicare ID - Type Unspecified