Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME145079 | FL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | S1574 | TX |
N | 207YS0123X | Facial Plastic Surgeon | ME145079 | FL |
N | 207YS0123X | Facial Plastic Surgeon | S1574 | TX |
NPI | 1053739391 |
---|---|
Provider Name | Kevin Jonathan Caceres |
First Address | Tampa, FL 33613-6601 |
Second Address | Tampa, FL 33613-6601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 21/09/2021 |