Healthcare Provider Details

I. General information

NPI: 1508804618
Provider Name (Legal Business Name): JORGE A. SALCEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CELEBRATION BLVD STE 407
CELEBRATION FL
34747-5165
US

IV. Provider business mailing address

PO BOX 25487
SARASOTA FL
34277-2487
US

V. Phone/Fax

Practice location:
  • Phone: 321-939-4137
  • Fax: 321-939-4109
Mailing address:
  • Phone: 941-216-0072
  • Fax: 877-807-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME142993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: