Provider Demographics
NPI:1992771497
Name:PALLAIS, JUAN C (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:PALLAIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BIGELOW TEACHING SERVICE INPATIENT GRB 740
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-7436
Practice Address - Fax:617-724-7441
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-11-29
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Provider Licenses
StateLicense IDTaxonomies
MA212911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2022371Medicaid
MA468507OtherTUFTS HEALTH PLAN
MAJ26820OtherBCBS MA
MAA36151Medicare ID - Type Unspecified
MA2022371Medicaid