Provider Demographics
NPI:1184695207
Name:ACEVEDO, VICTOR M (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:ACEVEDO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:647 DUNLOP LN STE 301
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5265
Mailing Address - Country:US
Mailing Address - Phone:270-461-5016
Mailing Address - Fax:931-645-4142
Practice Address - Street 1:650 JOEL DRIVE, BLACHFIELD ARMY COMMUNITY HOSPITA
Practice Address - Street 2:WHIT PRIMARY CARE CLINIC
Practice Address - City:FT. CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14705174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21309Medicare ID - Type Unspecified
PRH80164Medicare UPIN