Provider Demographics
NPI:1952414229
Name:PUERTO, JUAN A (MD PA)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:PUERTO
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:A
Other - Last Name:PUERTO-MERAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 160463
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-0463
Mailing Address - Country:US
Mailing Address - Phone:305-273-9923
Mailing Address - Fax:305-273-8825
Practice Address - Street 1:10661 N KENDALL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-273-9923
Practice Address - Fax:305-273-8825
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036313207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067457500Medicaid
FL067457500Medicaid
96228Medicare ID - Type Unspecified