Provider Demographics
NPI:1669424123
Name:CASADEVALLS, JUAN PEDRO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PEDRO
Last Name:CASADEVALLS
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 1:1201 5TH AVE N
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1433
Mailing Address - Country:US
Mailing Address - Phone:727-822-5410
Mailing Address - Fax:
Practice Address - Street 1:1201 5TH AVE N
Practice Address - Street 2:SUITE 410
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1433
Practice Address - Country:US
Practice Address - Phone:727-822-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 67511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273619500Medicaid
FLP00390046OtherRR MEDICARE
FLP00390046OtherRR MEDICARE