Provider Demographics
NPI:1407818586
Name:CACERES, JORGE LUIS JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:LUIS
Last Name:CACERES
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3186 BITTERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2518
Mailing Address - Country:US
Mailing Address - Phone:910-875-9087
Mailing Address - Fax:910-875-4597
Practice Address - Street 1:116 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2606
Practice Address - Country:US
Practice Address - Phone:910-875-9087
Practice Address - Fax:910-875-4597
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2010-09-02
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Provider Licenses
StateLicense IDTaxonomies
NCNC 102392363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS72482Medicare UPIN