Provider Demographics
NPI:1205410768
Name:PEREIRA, JUAN (DO)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:IGNACIO
Other - Last Name:PEREIRA DUQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:630 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2128
Practice Address - Country:US
Practice Address - Phone:727-360-1784
Practice Address - Fax:727-360-1823
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123792000Medicaid