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Provider Information for 1992760557

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

JUAN OTHEGUY MD

Gender: MALE

Individual NPI: 1992760557

Calendar   Last Updated:  2016-04-27
  Certification Date: 

Details

Name Value
NPI 1992760557
Enumeration Date 2006-04-18
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2075 LITTLE RD
TRINITY, FL 34655-4421
United States

Phone: 727-375-5520 | Fax: 727-375-1463
View Map External Link
Primary Practice Address 2075 LITTLE RD
TRINITY, FL 34655-4421
United States

Phone: 727-375-5520 | Fax: 727-375-1463
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 174400000X - Specialist FL ME-62352