Healthcare Provider Details

I. General information

NPI: 1740406289
Provider Name (Legal Business Name): JUANITA R FLEMING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 W JORDAN ST
PENSACOLA FL
32501-1736
US

IV. Provider business mailing address

14 W JORDAN ST
PENSACOLA FL
32501-1736
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-4630
  • Fax: 850-436-2095
Mailing address:
  • Phone: 850-436-4630
  • Fax: 850-436-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME116812
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME116812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: