Provider Demographics
NPI:1861592388
Name:DUARTE, JUAN P (M D PA)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:P
Last Name:DUARTE
Suffix:
Gender:M
Credentials:M D PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18926 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7711
Mailing Address - Country:US
Mailing Address - Phone:305-278-9677
Mailing Address - Fax:305-278-7757
Practice Address - Street 1:18926 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-7711
Practice Address - Country:US
Practice Address - Phone:305-278-9677
Practice Address - Fax:305-278-7757
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82779208D00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH52715Medicare UPIN
FLE6609CMedicare ID - Type Unspecified