MEDICARE: JUAN C GUARDERAS MD

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	207KA0200X	Allergy Physician	80320	GA
2	207K00000X	Allergy & Immunology Physician	80320	GA
3	207K00000X	Allergy & Immunology Physician	ME62732	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	030002009	OTHER	FL	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	18056	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1902893290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN C GUARDERAS MD

Provider Business Mailing Address
First Line	:	PO BOX 3068
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31604-3068
Country	:	US
Telephone Number	:	229-247-1667
Fax Number	:	229-245-7661

Provider Business Practice Location Address
First Line	:	3334 GREYSTONE WAY
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-1096
Country	:	US
Telephone Number	:	229-247-1667
Fax Number	:	229-245-7661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2005
Last Update Date	:	08/11/2022

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Directions to “ JUAN C GUARDERAS MD” Practice Location

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