Provider Demographics
NPI:1992794556
Name:SUAREZ, JUAN P (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:P
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:P
Other - Last Name:SUAREZ-LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1900 N MILLS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1444
Mailing Address - Country:US
Mailing Address - Phone:407-843-0151
Mailing Address - Fax:407-843-9230
Practice Address - Street 1:1900 N MILLS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1444
Practice Address - Country:US
Practice Address - Phone:407-843-0151
Practice Address - Fax:407-843-9230
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012966100Medicaid
FL044557600Medicaid
FL07291OtherBCBS/IND
FL006LLOtherBCBS/GROUP
FL07291ZOtherMEDICARE/PTAN-IND
FL086037OtherAVMED
FLCB957AOtherMEDICARE/PTAN-GROUP
FL012966100Medicaid