MEDICARE: DR. JUAN JOSE PINEDA 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	207R00000X	Internal Medicine Physician	R3P42	MO
2	207RG0100X	Gastroenterology Physician	R3P42	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110212405	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251779	OTHER	MO	HEALTHLINK
2	6520	OTHER	MO	BLUE CROSS/BLUE SHIELD/MO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386649812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN JOSE PINEDA M.D.

Provider Business Mailing Address
First Line	:	3300 VAWTER SCHOOL RD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-8609
Country	:	US
Telephone Number	:	573-445-9764
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 VAWTER SCHOOL RD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-8609
Country	:	US
Telephone Number	:	573-445-9764
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	08/15/2022

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