Provider Demographics
NPI:1912983255
Name:OJEDA, JUAN B (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:B
Last Name:OJEDA
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:P.O. BOX 145026
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-5026
Mailing Address - Country:US
Mailing Address - Phone:305-828-4300
Mailing Address - Fax:305-828-4940
Practice Address - Street 1:259 EAST 49TH STREET
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-828-4300
Practice Address - Fax:305-828-4940
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069041400Medicaid
FL069041400Medicaid
FL96JJ3Medicare PIN
D79004Medicare UPIN