Provider Demographics
NPI:1295849008
Name:ACAYLAR, FRANCIS VILLANUEVA
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:VILLANUEVA
Last Name:ACAYLAR
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7487
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:1076 MARLBORO WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2495
Practice Address - Country:US
Practice Address - Phone:843-479-0432
Practice Address - Fax:843-479-3036
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21032208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC210328Medicaid
SCH05856Medicare UPIN
SC210328Medicaid