Provider Demographics
NPI:1407081300
Name:CACERES SERRANO, MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:CACERES SERRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 COOSA ST E STE B
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2154
Mailing Address - Country:US
Mailing Address - Phone:256-761-0921
Mailing Address - Fax:256-761-0947
Practice Address - Street 1:109 COOSA ST E STE B
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2154
Practice Address - Country:US
Practice Address - Phone:256-761-0921
Practice Address - Fax:256-761-0947
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD29431208600000X
PAMD434060208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery