Healthcare Provider Details

I. General information

NPI: 1346537008
Provider Name (Legal Business Name): JUAN DAVID GUERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 100331 BOX 1
FPO AE
09513-3100
US

IV. Provider business mailing address

PSC 561 BOX 2694
FPO AP
96310-0027
US

V. Phone/Fax

Practice location:
  • Phone: 757-444-5668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101252988
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: