Provider Demographics
NPI:1437101599
Name:VOLCAN, ILDEMARO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ILDEMARO
Middle Name:JOSE
Last Name:VOLCAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1226 W WHEELER PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1870
Mailing Address - Country:US
Mailing Address - Phone:706-922-4450
Mailing Address - Fax:706-922-4453
Practice Address - Street 1:1226 W WHEELER PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1870
Practice Address - Country:US
Practice Address - Phone:706-922-4450
Practice Address - Fax:706-922-4453
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA017959207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD31178Medicare UPIN