MEDICARE: DR. JUAN CARLOS GALVEZ VARGAS 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	207Q00000X	Family Medicine Physician	036128480	IL
2	207Q00000X	Family Medicine Physician	A119932	CA
3	207Q00000X	Family Medicine Physician	53001	MN
4	207QS0010X	Sports Medicine (Family Medicine) Physician	ME126491	FL

General Provider Information

NPI Number	:	1689847568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS GALVEZ VARGAS M.D.

Provider Business Mailing Address
First Line	:	3702 WASHINGTON ST STE 202
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8283
Country	:	US
Telephone Number	:	954-964-6114
Fax Number	:	954-962-1994

Provider Business Practice Location Address
First Line	:	3702 WASHINGTON ST STE 202
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8283
Country	:	US
Telephone Number	:	954-964-6114
Fax Number	:	954-962-1994

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	09/12/2023

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