Basic Information
| Provider Information | |||||||||
| NPI: | 1669474318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRERE | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3661 S MIAMI AVE | ||||||||
| Address2: | STE 907 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331334214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143710600 | ||||||||
| FaxNumber: | 8143724764 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 SOUTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | DUBOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143710600 | ||||||||
| FaxNumber: | 8143724764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME85054 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | MD435438 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 17483X | 01 | FL | MEDICARE PTAN | OTHER | 285427 | 01 | FL | AVMED | OTHER | 100017048 | 01 | FL | RAILROAD MEDICARE | OTHER | 17483 | 01 | FL | BCBS | OTHER | 2134161 | 01 | FL | UNITED HEALTHCARE | OTHER | P00710404 | 01 | FL | RAILROAD MEDICARE | OTHER | 264308100 | 05 | FL | MEDICAID | 412687 | 01 | PA | UPMC | OTHER | 000423031 | 01 | PA | HIGHMARK | OTHER | 0032560 | 01 | FL | CIGNA | OTHER | 102241660 | 05 | PA | MEDICAID | 1669474318 | 01 | FL | TRICARE | OTHER | 7662289 | 01 | FL | AETNA | OTHER | 143491 | 01 | PA | MEDICARE PTAN | OTHER | 1616507 | 01 | PA | GATEWAY | OTHER | 2499134 | 01 | FL | GHI | OTHER |