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NPI Code Detail

MEDICARE: JUAN ANTONIO CARMONA MD

MEDICARE: JUAN ANTONIO CARMONA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician19664PR
2207Q00000XFamily Medicine PhysicianACN962FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083153761
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN ANTONIO CARMONA MD
Provider Business Mailing Address
First Line : 2307 BOLADO PKWY
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2712
Country : US
Telephone Number : 239-297-9730
Fax Number : 239-257-3827
Provider Business Practice Location Address
First Line : 2307 BOLADO PKWY
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2712
Country : US
Telephone Number : 239-424-8122
Fax Number : 239-257-3827
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2017
Last Update Date : 08/31/2022

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Directions to “ JUAN ANTONIO CARMONA MD” Practice Location

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