MEDICARE: DR. JUAN CARLOS BARRAGAN D.P.M.

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	213E00000X	Podiatrist	N004648-1	NY

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	:	1962401190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS BARRAGAN D.P.M.

Provider Business Mailing Address
First Line	:	1561 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-2912
Country	:	US
Telephone Number	:	718-328-6200
Fax Number	:	718-328-6733

Provider Business Practice Location Address
First Line	:	1561 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-2912
Country	:	US
Telephone Number	:	718-328-6200
Fax Number	:	718-328-6733

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	01/29/2013

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