Provider Demographics
NPI:1639132236
Name:CANCEMI, ERIC THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:THEODORE
Last Name:CANCEMI
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 1:5999 SOUTH CUSTER ROAD
Mailing Address - Street 2:SUITE 110 PMB 125
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6867
Mailing Address - Country:US
Mailing Address - Phone:214-681-1010
Mailing Address - Fax:214-842-8564
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2096
Practice Address - Country:US
Practice Address - Phone:214-820-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5077207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029466201Medicaid
TX00053LMedicare ID - Type Unspecified
TX029466201Medicaid