1992794556 NPI number — DR. JUAN P SUAREZ MD

Table of content: DR. JUAN P SUAREZ MD (NPI 1992794556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992794556 NPI number — DR. JUAN P SUAREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUAREZ
Provider First Name:
JUAN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUAREZ-LOPEZ
Provider Other First Name:
JUAN
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1992794556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 N MILLS AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32803-1444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-843-0151
Provider Business Mailing Address Fax Number:
407-843-9230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 N MILLS AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-843-0151
Provider Business Practice Location Address Fax Number:
407-843-9230
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME0053735 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012966100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044557600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07291 . This is a "BCBS/IND" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 006LL . This is a "BCBS/GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 07291Z . This is a "MEDICARE/PTAN-IND" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 086037 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CB957A . This is a "MEDICARE/PTAN-GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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