Healthcare Provider Details

I. General information

NPI: 1124219399
Provider Name (Legal Business Name): JUAN P DUARTE MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18926 S DIXIE HWY
CUTLER BAY FL
33157-7711
US

IV. Provider business mailing address

18926 S DIXIE HWY
CUTLER BAY FL
33157-7711
US

V. Phone/Fax

Practice location:
  • Phone: 305-278-9677
  • Fax: 305-278-7757
Mailing address:
  • Phone: 305-278-9677
  • Fax: 305-278-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME82779
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME82779
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN P DUARTE
Title or Position: DIRECTOR
Credential: M.D.
Phone: 305-278-9677