Provider Demographics
NPI:1487855987
Name:FUENTES, JUAN CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:FUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100237
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0237
Mailing Address - Country:US
Mailing Address - Phone:904-819-1005
Mailing Address - Fax:904-819-1002
Practice Address - Street 1:2570 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4588
Practice Address - Country:US
Practice Address - Phone:904-819-1005
Practice Address - Fax:904-819-1002
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME99492207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01389011OtherRAILROAD MEDICARE
FL1487855987Medicaid