Individual
DR. JUAN CAMILO MORA HERRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-0254
(352) 273-8610
Mailing address
PO BOX 100254, GAINESVILLE, FL 32610-0254
(352) 273-8610
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME133793
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100014500
—
FL
Enumeration date
04/15/2013
Last updated
12/12/2018
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