Provider Demographics
NPI:1457321218
Name:ACEBO, RAYMOND BURNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:BURNETT
Last Name:ACEBO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1521 S STAPLES ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3150
Mailing Address - Country:US
Mailing Address - Phone:361-694-1498
Mailing Address - Fax:361-694-1499
Practice Address - Street 1:1521 S STAPLES ST STE 300
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3150
Practice Address - Country:US
Practice Address - Phone:361-694-1498
Practice Address - Fax:361-694-1499
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH9742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137558611Medicaid
TX379706YLPSOtherWELLMED PTAN
TX379706YLPSOtherWELLMED PTAN