MEDICARE: EUGENIO MOISES GUEVARA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician
2	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790043420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENIO MOISES GUEVARA MD PA

Provider Business Mailing Address
First Line	:	777 E 25TH ST STE 319
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3849
Country	:	US
Telephone Number	:	305-693-8585
Fax Number	:	305-693-8595

Provider Business Practice Location Address
First Line	:	777 E 25TH ST STE 319
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3849
Country	:	US
Telephone Number	:	305-693-8585
Fax Number	:	305-693-8595

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUGENIO MOISES GUEVARA
Credential	:	M.D.
Telephone Number	:	305-693-8585

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	04/22/2019

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