Provider Demographics
NPI:1760487748
Name:SALCEDO, RAUL A (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:A
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3814
Mailing Address - Country:US
Mailing Address - Phone:904-475-2039
Mailing Address - Fax:
Practice Address - Street 1:3720 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3814
Practice Address - Country:US
Practice Address - Phone:904-475-2039
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0048056OtherMCA
PR073019OtherHEALTL INSURANCE
PR9590047OtherHEALTH INSURANCE
PRSA48056OtherHEALTH INSURANCE
PR9590047OtherHEALTH INSURANCE