Provider Demographics
NPI:1760432223
Name:CANCIO ACEVEDO, JUAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:F
Last Name:CANCIO ACEVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34187
Mailing Address - Street 2:
Mailing Address - City:FORT BUCHANAN
Mailing Address - State:PR
Mailing Address - Zip Code:00934-0187
Mailing Address - Country:US
Mailing Address - Phone:787-263-0644
Mailing Address - Fax:787-535-1024
Practice Address - Street 1:706 CALLE ROOSEVELT
Practice Address - Street 2:SUITE 1001 NORTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3402
Practice Address - Country:US
Practice Address - Phone:787-263-0644
Practice Address - Fax:787-535-1024
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR129842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7360037Medicaid
B74837Medicare UPIN
20165Medicare ID - Type Unspecified