Healthcare Provider Details

I. General information

NPI: 1487889093
Provider Name (Legal Business Name): JOHAN JUDE BARRETTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

6811 SW 80TH DR
GAINESVILLE FL
32608-7562
US

V. Phone/Fax

Practice location:
  • Phone: 352-594-3589
  • Fax: 352-265-0379
Mailing address:
  • Phone: 832-585-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME113063
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME113063
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME113063
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME113063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: