Healthcare Provider Details

I. General information

NPI: 1326016536
Provider Name (Legal Business Name): IVAN A GUERRERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 802
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

P.O. BOX 551272
JACKSONVILLE FL
32255-1272
US

V. Phone/Fax

Practice location:
  • Phone: 904-646-1987
  • Fax: 904-646-1501
Mailing address:
  • Phone: 904-646-1987
  • Fax: 904-646-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME82361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: