Provider Demographics
NPI:1801991054
Name:CAPARROS GONZALEZ, JUAN L (MD)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:L
Last Name:CAPARROS GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5245 US HIGHWAY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-0516
Mailing Address - Country:US
Mailing Address - Phone:863-606-1616
Mailing Address - Fax:863-606-3171
Practice Address - Street 1:1760 HAVENDALE BLVD NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1224
Practice Address - Country:US
Practice Address - Phone:863-662-3007
Practice Address - Fax:863-875-4681
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10777208D00000X
FLACN971208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82945Medicare ID - Type Unspecified
PRF50394Medicare UPIN