Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 69602-20 | WI |
Y | 207QS0010X | Family Doctor - Sports Medicine | S3986 | TX |
NPI | 1154715142 |
---|---|
Provider Name | Dr. Juan Guzman JR. |
First Address | Austin, TX 78712-1850 |
Second Address | Austin, TX 78712-1765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 04/06/2020 |