Healthcare Provider Details

I. General information

NPI: 1346200292
Provider Name (Legal Business Name): JUAN JUAREZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-5150
  • Fax:
Mailing address:
  • Phone: 402-955-8744
  • Fax: 402-955-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberL4479
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: