Provider Demographics
NPI:1902052756
Name:FERNANDEZ- MACEIRO, JUAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:E
Last Name:FERNANDEZ- MACEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:308 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5001
Mailing Address - Country:US
Mailing Address - Phone:407-483-8801
Mailing Address - Fax:407-483-1298
Practice Address - Street 1:931 W OAK ST
Practice Address - Street 2:STE 103
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4973
Practice Address - Country:US
Practice Address - Phone:407-931-0444
Practice Address - Fax:407-962-4446
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR17259208D00000X
FLACN302208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBN836ZMedicare PIN