Provider Demographics
NPI:1720093263
Name:SERALDE, CIRILO M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CIRILO
Middle Name:M
Last Name:SERALDE
Suffix:JR
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 1:343 S COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-3607
Mailing Address - Country:US
Mailing Address - Phone:863-382-2772
Mailing Address - Fax:863-382-3172
Practice Address - Street 1:343 S COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3607
Practice Address - Country:US
Practice Address - Phone:863-382-2772
Practice Address - Fax:863-382-3172
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043253208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41214ZOtherMEDICARE PROVIDER NUMBER FOR SEBRING MEDICAL WALK-IN CLINIC
FL068235700Medicaid
FL41214OtherMEDICARE INDIVIDUAL PROVIDER
FLME0043253OtherFLORIDA PHYSICIAN LICENSE
FL41214COtherMEDICARE PROVIDER NUMBER FAIRMOUNT WALK-IN MEDICAL CLINIC
FL41214COtherMEDICARE PROVIDER NUMBER FAIRMOUNT WALK-IN MEDICAL CLINIC
FL41214ZOtherMEDICARE PROVIDER NUMBER FOR SEBRING MEDICAL WALK-IN CLINIC
FLAS2462682OtherDEA