Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME77843 | FL |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME0077843 | FL |
NPI | 1710969225 |
---|---|
Provider Name | Jorge I Acevedo |
First Address | Jacksonville, FL 32216-8070 |
Second Address | Jacksonville, FL 32204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 25/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G86735 | (02) | |
ME77843 | MEDICAL LICENSE (01) | FL |