Provider Demographics
NPI:1508804618
Name:SALCEDO, JORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-216-0072
Mailing Address - Fax:877-807-0253
Practice Address - Street 1:1530 CELEBRATION BLVD STE 407
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5165
Practice Address - Country:US
Practice Address - Phone:321-939-4137
Practice Address - Fax:321-939-4109
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8J3267Medicare PIN
I71582Medicare UPIN