Healthcare Provider Details

I. General information

NPI: 1063675478
Provider Name (Legal Business Name): JUAN JOSE EGAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN JOSE EGAS

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

2007 W SWANN AVE STE B
TAMPA FL
33606-2483
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8610
  • Fax:
Mailing address:
  • Phone: 813-981-3382
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME129841
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME129841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: