Provider Demographics
NPI:1942647656
Name:GUZMAN, JOHNNY DIMAS (DO, MS)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:DIMAS
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3924
Mailing Address - Country:US
Mailing Address - Phone:855-955-5428
Mailing Address - Fax:844-389-0835
Practice Address - Street 1:2307 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-3924
Practice Address - Country:US
Practice Address - Phone:855-955-5428
Practice Address - Fax:844-389-0835
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO034618207Q00000X
390200000X
FLOS16879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program