Individual
JUAN C GUARDERAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3334 GREYSTONE WAY, VALDOSTA, GA 31605-1096
(229) 247-1667
(229) 245-7661
Mailing address
PO BOX 3068, VALDOSTA, GA 31604-3068
(229) 247-1667
(229) 245-7661
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
80320
GA
207K00000X
Allergy & Immunology Physician
ME62732
FL
207KA0200X
Allergy Physician
80320
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000892966A
—
GA
01
—
030002009
RAILROAD MEDICARE
FL
01
—
18056
BLUE CROSS/BLUE SHIELD
FL
05
—
261325500
—
FL
Enumeration date
10/01/2005
Last updated
08/11/2022
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