MEDICARE: DR. JUAN FERNANDO CACERES M.D.

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
1	207V00000X	Obstetrics & Gynecology Physician	F8817	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2320788	OTHER	TX	AETNA INSURANCE COMPANY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0017CL	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1154305902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN FERNANDO CACERES M.D.

Provider Business Mailing Address
First Line	:	5920 SARATOGA BLVD
Second Line	:	SUITE 160
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4103
Country	:	US
Telephone Number	:	361-985-8884
Fax Number	:	361-985-9935

Provider Business Practice Location Address
First Line	:	5920 SARATOGA BLVD
Second Line	:	SUITE 160
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4103
Country	:	US
Telephone Number	:	361-985-8884
Fax Number	:	361-985-9935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/09/2010

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Directions to “ DR. JUAN FERNANDO CACERES M.D.” Practice Location

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