Provider Demographics
NPI:1285601948
Name:GUZMAN, LUIS A (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:ALBERTO CUNEO
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-6511
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85888207RC0000X
NC2020-00205207RI0011X, 207RC0000X
VA0101258670207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2660563-00Medicaid
GA390691266AMedicaid
GA390691266AMedicaid
FL62967WMedicare PIN
FL2660563-00Medicaid