Provider Demographics
NPI:1528014313
Name:ACEVEDO, WILLIAM BERNARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BERNARDO
Last Name:ACEVEDO
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 1:726 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2530
Mailing Address - Country:US
Mailing Address - Phone:352-754-1253
Mailing Address - Fax:352-754-1293
Practice Address - Street 1:726 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2530
Practice Address - Country:US
Practice Address - Phone:352-754-1253
Practice Address - Fax:352-754-1293
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266461500Medicaid