MEDICARE: JUAN J CARRERE 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	207RG0100X	Gastroenterology Physician	ME85054	FL
2	207RG0100X	Gastroenterology Physician	MD435438	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17483X	OTHER	FL	MEDICARE PTAN
3	100017048	OTHER	FL	RAILROAD MEDICARE
6	P00710404	OTHER	FL	RAILROAD MEDICARE
14	143491	OTHER	PA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	285427	OTHER	FL	AVMED
4	17483	OTHER	FL	BCBS
5	2134161	OTHER	FL	UNITED HEALTHCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	412687	OTHER	PA	UPMC
9	000423031	OTHER	PA	HIGHMARK
10	0032560	OTHER	FL	CIGNA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	1669474318	OTHER	FL	TRICARE
13	7662289	OTHER	FL	AETNA
15	1616507	OTHER	PA	GATEWAY
16	2499134	OTHER	FL	GHI

General Provider Information

NPI Number	:	1669474318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN J CARRERE M.D.

Provider Business Mailing Address
First Line	:	3661 S MIAMI AVE
Second Line	:	STE 907
City	:	MIAMI
State	:	FL
Zip	:	33133-4214
Country	:	US
Telephone Number	:	814-371-0600
Fax Number	:	814-372-4764

Provider Business Practice Location Address
First Line	:	621 SOUTH MAIN STREET
Second Line	:
City	:	DUBOIS
State	:	PA
Zip	:	15801
Country	:	US
Telephone Number	:	814-371-0600
Fax Number	:	814-372-4764

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	11/05/2019

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