Provider Demographics
NPI:1235159948
Name:ACEVEDO, ELIUD
Entity Type:Individual
Prefix:DR
First Name:ELIUD
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 JACAMAN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6194
Mailing Address - Country:US
Mailing Address - Phone:956-725-1777
Mailing Address - Fax:956-725-6510
Practice Address - Street 1:1405 JACAMAN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6194
Practice Address - Country:US
Practice Address - Phone:956-725-1777
Practice Address - Fax:956-725-6510
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ255OtherBLUE CROSS & BLUE SHIELD
TX1233983-05Medicaid
TX8AJ255OtherBLUE CROSS & BLUE SHIELD
TX8C0440Medicare PIN