Healthcare Provider Details

I. General information

NPI: 1093795692
Provider Name (Legal Business Name): JEROME GUZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S HARBOR CITY BLVD SUITE 100
MELBOURNE FL
32901-1938
US

IV. Provider business mailing address

220 N. SYKES CREEK PKWY SUITE 200
MERRITT ISLAND FL
32955
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-2225
  • Fax: 321-308-0635
Mailing address:
  • Phone: 321-459-1446
  • Fax: 321-452-1261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME46149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: