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General NPI Number Information
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NPI Number | 1689825358
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Entity Type | Organization
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Legal Business Name | JUAN J CARRERE MD LLC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 13710 METROPOLIS AVE SUITE 110
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City | FORT MYERS
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State | FL
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Zip | 33912-7144
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Country | US
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Telephone | 239-415-2273
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Fax | 239-415-2280
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Provider Business Mailing Address
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Address Line | 1633 TREASURE LK
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City | DU BOIS
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State | PA
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Zip | 15801-9043
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Country | US
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Telephone | 814-913-1440
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Fax | 814-913-1440
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JUAN J CARRERE
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Credential | MD
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Telephone | 814-913-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME85054
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License Number State | FL
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