1386090520 NPI number — DR. JUAN MANUEL GUERRA D.O.

Table of content: DR. JUAN MANUEL GUERRA D.O. (NPI 1386090520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386090520 NPI number — DR. JUAN MANUEL GUERRA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERRA
Provider First Name:
JUAN
Provider Middle Name:
MANUEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386090520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3960 NEW COVINGTON PIKE EMERGENCY DEPARTMENT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-516-5211
Provider Business Mailing Address Fax Number:
901-516-3880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3960 NEW COVINGTON PIKE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-516-5211
Provider Business Practice Location Address Fax Number:
901-516-3880
Provider Enumeration Date:
05/06/2016

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 3537 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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