Provider Demographics
NPI:1447352760
Name:BARALT, JUAN R (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:BARALT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#1329 NW 101ST DRIVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8036
Mailing Address - Country:US
Mailing Address - Phone:352-332-5740
Mailing Address - Fax:
Practice Address - Street 1:619 SOUTH MARION
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD013556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD013556OtherPATHOLOGY
LAMD013556OtherGENERAL SURGERY
LAMD013556OtherONCOLOGY